Provider Demographics
NPI: | 1508174574 |
---|---|
Name: | THERAPY DYNAMICS, INC. |
Entity Type: | Organization |
Organization Name: | THERAPY DYNAMICS, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO/CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CARLA |
Authorized Official - Middle Name: | D |
Authorized Official - Last Name: | VARELA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OTR, HTC |
Authorized Official - Phone: | 626-943-9153 |
Mailing Address - Street 1: | 1608 S OLIVE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALHAMBRA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91803-3158 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 626-943-9153 |
Mailing Address - Fax: | 626-943-9216 |
Practice Address - Street 1: | 1608 S OLIVE AVE |
Practice Address - Street 2: | |
Practice Address - City: | ALHAMBRA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91803-3158 |
Practice Address - Country: | US |
Practice Address - Phone: | 626-943-9153 |
Practice Address - Fax: | 626-943-9216 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-09-23 |
Last Update Date: | 2010-09-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
224Z00000X, 225100000X, 225200000X, 225X00000X, 225XL0004X, 225XP0019X | ||
CA | OT7380 | 225XH1200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 225XL0004X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Low Vision | Group - Multi-Specialty |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |