Provider Demographics
NPI:1942474754
Name:OZ DYNAMIC THERAPY
Entity Type:Organization
Organization Name:OZ DYNAMIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OS
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDESSARI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-884-3118
Mailing Address - Street 1:PO BOX 40189
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-0189
Mailing Address - Country:US
Mailing Address - Phone:303-884-3118
Mailing Address - Fax:303-321-0620
Practice Address - Street 1:17109 CAMPION WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9124
Practice Address - Country:US
Practice Address - Phone:303-884-3118
Practice Address - Fax:303-321-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO73142251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty