Provider Demographics
NPI:1134775174
Name:DYNAMIC PHYSICAL THERAPY REHAB OF NY P.C.
Entity type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY REHAB OF NY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KINCHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NONOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-884-5987
Mailing Address - Street 1:157 ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2345
Mailing Address - Country:US
Mailing Address - Phone:213-884-5987
Mailing Address - Fax:718-228-7628
Practice Address - Street 1:157 ANDREWS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2345
Practice Address - Country:US
Practice Address - Phone:213-884-5987
Practice Address - Fax:718-228-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy