Provider Demographics
NPI:1972775955
Name:DYNAMIC CARE PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:DYNAMIC CARE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-680-9781
Mailing Address - Street 1:235 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1209
Mailing Address - Country:US
Mailing Address - Phone:516-371-5410
Mailing Address - Fax:
Practice Address - Street 1:235 MILL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1209
Practice Address - Country:US
Practice Address - Phone:516-371-5410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-30
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy