Provider Demographics
NPI:1619207867
Name:DYNAMICO PHYSICAL THERAPY AND REHABILITATION CENTER SC
Entity Type:Organization
Organization Name:DYNAMICO PHYSICAL THERAPY AND REHABILITATION CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYEH
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:MIRSHED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-424-6367
Mailing Address - Street 1:4255 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4255 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5041
Practice Address - Country:US
Practice Address - Phone:773-424-6367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy