Provider Demographics
NPI:1750864435
Name:DYNAMIC THERAPEUTIC CARE SLP PLLC
Entity Type:Organization
Organization Name:DYNAMIC THERAPEUTIC CARE SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:REZIA
Authorized Official - Middle Name:YOSHIKA
Authorized Official - Last Name:LUKE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP- CCC
Authorized Official - Phone:718-913-3494
Mailing Address - Street 1:PO BOX 30387
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-0387
Mailing Address - Country:US
Mailing Address - Phone:718-913-3494
Mailing Address - Fax:
Practice Address - Street 1:495 FLATBUSH AVE STE 21
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3706
Practice Address - Country:US
Practice Address - Phone:877-585-0047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty