Provider Demographics
NPI:1700221371
Name:DYNAMIC HEALTH PHYSICAL THERAPY
Entity Type:Organization
Organization Name:DYNAMIC HEALTH PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:860-930-4924
Mailing Address - Street 1:35 TOWER LANE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4237
Mailing Address - Country:US
Mailing Address - Phone:860-404-2549
Mailing Address - Fax:860-404-2621
Practice Address - Street 1:35 TOWER LANE
Practice Address - Street 2:SUITE 110
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4237
Practice Address - Country:US
Practice Address - Phone:860-404-2549
Practice Address - Fax:860-404-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006036261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy