Provider Demographics
NPI:1356597868
Name:DYNAMIC PHYSICAL THERAPY MANAGEMENT SERVICES
Entity type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:OURY
Authorized Official - Suffix:
Authorized Official - Credentials:PT,MS,CFMT
Authorized Official - Phone:630-876-9186
Mailing Address - Street 1:440 E. ROOSEVELT ROAD
Mailing Address - Street 2:UNIT 104
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-3902
Mailing Address - Country:US
Mailing Address - Phone:630-876-9186
Mailing Address - Fax:630-876-9187
Practice Address - Street 1:440 E ROOSEVELT RD
Practice Address - Street 2:UNIT 104
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-3902
Practice Address - Country:US
Practice Address - Phone:630-876-9186
Practice Address - Fax:630-876-9187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty