Provider Demographics
NPI:1457728255
Name:DYNAMIC THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:DYNAMIC THERAPY SERVICES LLC
Other - Org Name:PIVOT PHYSICAL THERAPY OF MID ATLANTIC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-258-2714
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12216 OCEAN GTWY
Practice Address - Street 2:UNITE 1200
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9790
Practice Address - Country:US
Practice Address - Phone:410-390-5912
Practice Address - Fax:410-390-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty