Provider Demographics
NPI:1295327740
Name:DYNAMIC MOVEMENT PHYSICAL THERAPY AND WELLNESS
Entity type:Organization
Organization Name:DYNAMIC MOVEMENT PHYSICAL THERAPY AND WELLNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, ATC
Authorized Official - Phone:908-627-3033
Mailing Address - Street 1:122 BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1822
Mailing Address - Country:US
Mailing Address - Phone:908-627-3033
Mailing Address - Fax:
Practice Address - Street 1:122 BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-1822
Practice Address - Country:US
Practice Address - Phone:908-627-3033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy