Provider Demographics
NPI:1609874288
Name:DYNAMIC PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KARSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-876-0010
Mailing Address - Street 1:8872 PROFESSIONAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8481
Mailing Address - Country:US
Mailing Address - Phone:231-876-0010
Mailing Address - Fax:231-876-1246
Practice Address - Street 1:8872 PROFESSIONAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8481
Practice Address - Country:US
Practice Address - Phone:231-876-0010
Practice Address - Fax:231-876-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P36520Medicare PIN
MI236750Medicare Oscar/Certification