Provider Demographics
NPI:1295926350
Name:DYNAMIC REHAB HAND THERAPY, INC
Entity type:Organization
Organization Name:DYNAMIC REHAB HAND THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MONACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:480-980-1732
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-0729
Mailing Address - Country:US
Mailing Address - Phone:480-813-7900
Mailing Address - Fax:480-813-7901
Practice Address - Street 1:2940 E BANNER GATEWAY DR STE 425
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2177
Practice Address - Country:US
Practice Address - Phone:480-813-7900
Practice Address - Fax:480-813-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1076332BC3200X
AZ669332BC3200X
AZ2890332BC3200X
AZ3256332BC3200X
AZ1930332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment