Provider Demographics
NPI:1942467139
Name:DYNAMIC REHAB LLC
Entity Type:Organization
Organization Name:DYNAMIC REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAMPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-942-4988
Mailing Address - Street 1:1618 MAHAN CENTER BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5477
Mailing Address - Country:US
Mailing Address - Phone:850-325-6307
Mailing Address - Fax:850-325-6387
Practice Address - Street 1:1618 MAHAN CENTER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5477
Practice Address - Country:US
Practice Address - Phone:850-325-6307
Practice Address - Fax:850-325-6387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty