Provider Demographics
NPI:1700079977
Name:DYNAMIC DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:DYNAMIC DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WYONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-230-2715
Mailing Address - Street 1:2461 S HALLMARK DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-3911
Mailing Address - Country:US
Mailing Address - Phone:843-230-2715
Mailing Address - Fax:843-662-1236
Practice Address - Street 1:2461 S HALLMARK DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-3911
Practice Address - Country:US
Practice Address - Phone:843-230-2715
Practice Address - Fax:843-662-1236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21062251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty