Provider Demographics
NPI:1497075758
Name:DYNAMIC THERAPY & REHABILITATION CENTER
Entity Type:Organization
Organization Name:DYNAMIC THERAPY & REHABILITATION CENTER
Other - Org Name:DYNAMIC THERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALONZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:OTR
Authorized Official - Phone:305-316-4559
Mailing Address - Street 1:9370 SW 72ND ST
Mailing Address - Street 2:SUITE A212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5431
Mailing Address - Country:US
Mailing Address - Phone:786-401-6722
Mailing Address - Fax:786-401-6041
Practice Address - Street 1:3964 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-6291
Practice Address - Country:US
Practice Address - Phone:305-430-9499
Practice Address - Fax:305-574-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8785225100000X
FLPTA19241225200000X
FLOTR12543225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty