Provider Demographics
NPI:1669619268
Name:DYNAMIX PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DYNAMIX PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HUFFSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:731-613-2214
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-1004
Mailing Address - Country:US
Mailing Address - Phone:731-613-2214
Mailing Address - Fax:731-613-2215
Practice Address - Street 1:2060 RHINO XING
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-5201
Practice Address - Country:US
Practice Address - Phone:731-613-2214
Practice Address - Fax:731-613-2215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy