Provider Demographics
NPI:1538110242
Name:DYNAMIC THERAPY, LLC
Entity Type:Organization
Organization Name:DYNAMIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERALYN
Authorized Official - Middle Name:KING
Authorized Official - Last Name:CALLIHAN-FAVROT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-749-2065
Mailing Address - Street 1:309 S. VAUGHN DRIVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:BRUSLY
Mailing Address - State:LA
Mailing Address - Zip Code:70719
Mailing Address - Country:US
Mailing Address - Phone:225-749-2065
Mailing Address - Fax:225-749-2427
Practice Address - Street 1:309 S. VAUGHN DRIVE
Practice Address - Street 2:SUITE F
Practice Address - City:BRUSLY
Practice Address - State:LA
Practice Address - Zip Code:70719
Practice Address - Country:US
Practice Address - Phone:225-749-2065
Practice Address - Fax:225-749-2427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG9567OtherBLUE CROSS
LA5CM98Medicare ID - Type Unspecified