Provider Demographics
NPI:1801206362
Name:DYNAMIX PT
Entity Type:Organization
Organization Name:DYNAMIX PT
Other - Org Name:DYNAMIX PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ASSAD
Authorized Official - Last Name:KAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:575-415-4417
Mailing Address - Street 1:407 CORONADO DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6022
Mailing Address - Country:US
Mailing Address - Phone:575-415-4417
Mailing Address - Fax:
Practice Address - Street 1:407 CORONADO DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6022
Practice Address - Country:US
Practice Address - Phone:575-415-4417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4018225100000X
NM4019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty