Provider Demographics
NPI:1710572011
Name:B DYNAMIC HEALTHWEAR LLC
Entity Type:Organization
Organization Name:B DYNAMIC HEALTHWEAR LLC
Other - Org Name:DYNAMIC START LAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN, MED
Authorized Official - Phone:614-332-2392
Mailing Address - Street 1:4699 SAHALEE DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8179
Mailing Address - Country:US
Mailing Address - Phone:614-332-2392
Mailing Address - Fax:
Practice Address - Street 1:4699 SAHALEE DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8179
Practice Address - Country:US
Practice Address - Phone:614-332-2392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory