Provider Demographics
NPI:1972918100
Name:DYNAMIC THERAPY GROUP LLC
Entity Type:Organization
Organization Name:DYNAMIC THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LESSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-759-1371
Mailing Address - Street 1:9 HEWLETT ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-1616
Mailing Address - Country:US
Mailing Address - Phone:203-759-1371
Mailing Address - Fax:203-504-7922
Practice Address - Street 1:9 HEWLETT ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-1616
Practice Address - Country:US
Practice Address - Phone:203-759-1371
Practice Address - Fax:203-504-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty