Provider Demographics
NPI:1669007316
Name:DYNAMIC SWING PERFORMANCE, LLC
Entity Type:Organization
Organization Name:DYNAMIC SWING PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:404-271-4245
Mailing Address - Street 1:2031 COBBLESTONE CIR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-4909
Mailing Address - Country:US
Mailing Address - Phone:404-271-4245
Mailing Address - Fax:
Practice Address - Street 1:2031 COBBLESTONE CIR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-4909
Practice Address - Country:US
Practice Address - Phone:404-271-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty