Provider Demographics
NPI:1821366212
Name:DYNAMIC THERAPEUTIC SERVICES OF VIRGINIA
Entity Type:Organization
Organization Name:DYNAMIC THERAPEUTIC SERVICES OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-380-6611
Mailing Address - Street 1:14 E CUSTIS AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1422
Mailing Address - Country:US
Mailing Address - Phone:866-380-6611
Mailing Address - Fax:866-695-0107
Practice Address - Street 1:14 E CUSTIS AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-1422
Practice Address - Country:US
Practice Address - Phone:866-380-6611
Practice Address - Fax:866-695-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency