Provider Demographics
NPI:1497090302
Name:DYNAMIC PHYSIOTHERAPY SERVICES CORP
Entity Type:Organization
Organization Name:DYNAMIC PHYSIOTHERAPY SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WITOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIERZWA
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:773-354-3063
Mailing Address - Street 1:601 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-2206
Mailing Address - Country:US
Mailing Address - Phone:773-354-3063
Mailing Address - Fax:
Practice Address - Street 1:4601 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4718
Practice Address - Country:US
Practice Address - Phone:708-422-3422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty