Provider Demographics
NPI:1891017034
Name:DYNAMIC PHYSICAL THERAPY AND SPORTS REHABILITATIONS
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY AND SPORTS REHABILITATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:201-757-0669
Mailing Address - Street 1:220 LIVINGSTON ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NORTHVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07647-1738
Mailing Address - Country:US
Mailing Address - Phone:201-757-0669
Mailing Address - Fax:
Practice Address - Street 1:220 LIVINGSTON ST
Practice Address - Street 2:SUITE 112
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1738
Practice Address - Country:US
Practice Address - Phone:201-564-7515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty