Provider Demographics
NPI:1437407335
Name:PRODYNAMICS INC.
Entity Type:Organization
Organization Name:PRODYNAMICS INC.
Other - Org Name:TITAN PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:424-228-4340
Mailing Address - Street 1:12099 W WASHINGTON BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-2620
Mailing Address - Country:US
Mailing Address - Phone:424-228-4340
Mailing Address - Fax:424-228-4109
Practice Address - Street 1:12099 W WASHINGTON BLVD STE 408
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-2620
Practice Address - Country:US
Practice Address - Phone:424-228-4340
Practice Address - Fax:424-228-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27141261QP2000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy