Provider Demographics
NPI:1336774967
Name:DYNAMIC PHYSIO THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:DYNAMIC PHYSIO THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:239-919-7139
Mailing Address - Street 1:2241 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-4319
Mailing Address - Country:US
Mailing Address - Phone:239-919-7139
Mailing Address - Fax:833-876-8887
Practice Address - Street 1:1110 PINE RIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-8927
Practice Address - Country:US
Practice Address - Phone:239-919-7139
Practice Address - Fax:833-876-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy