Provider Demographics
NPI:1457330524
Name:DYNAMIC REHAB SERVICE
Entity Type:Organization
Organization Name:DYNAMIC REHAB SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-557-0333
Mailing Address - Street 1:1840 W 49TH ST
Mailing Address - Street 2:STE 304
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012
Mailing Address - Country:US
Mailing Address - Phone:305-557-0333
Mailing Address - Fax:305-557-0302
Practice Address - Street 1:1840 W 49TH ST
Practice Address - Street 2:STE 304
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2942
Practice Address - Country:US
Practice Address - Phone:305-557-0333
Practice Address - Fax:305-557-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3692Medicare ID - Type Unspecified