Provider Demographics
NPI:1528395571
Name:DYNAMIC THERAPEUTIC CENTER, INC
Entity Type:Organization
Organization Name:DYNAMIC THERAPEUTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REY BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-277-1058
Mailing Address - Street 1:6555 NW 36TH ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6978
Mailing Address - Country:US
Mailing Address - Phone:786-277-1058
Mailing Address - Fax:
Practice Address - Street 1:6555 NW 36TH ST
Practice Address - Street 2:SUITE 214
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6978
Practice Address - Country:US
Practice Address - Phone:786-277-1058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51139273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA51139OtherMASSAGE THERAPY LICENSE