Provider Demographics
NPI:1760704126
Name:DYNAMIC HEALTH SERVICES
Entity Type:Organization
Organization Name:DYNAMIC HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:757-639-3153
Mailing Address - Street 1:2254A MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1308
Mailing Address - Country:US
Mailing Address - Phone:757-639-3153
Mailing Address - Fax:757-318-9151
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:BLDG 3300 SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5765
Practice Address - Country:US
Practice Address - Phone:757-639-3153
Practice Address - Fax:757-318-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003917261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP28420Medicare UPIN
VA650000414Medicare PIN