Provider Demographics
NPI:1740239946
Name:DYNAMIC REHABILITATION SERVICES INC
Entity Type:Organization
Organization Name:DYNAMIC REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:215-872-8760
Mailing Address - Street 1:PO BOX 26733
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-0733
Mailing Address - Country:US
Mailing Address - Phone:215-782-8760
Mailing Address - Fax:215-635-7130
Practice Address - Street 1:8080 OLD YORK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1421
Practice Address - Country:US
Practice Address - Phone:215-782-8760
Practice Address - Fax:215-635-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01517814Medicaid
PA093051Medicare ID - Type Unspecified