Provider Demographics
NPI:1720347529
Name:DYNAMIC PHYSICAL REHAB INC
Entity Type:Organization
Organization Name:DYNAMIC PHYSICAL REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVELLAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-698-2270
Mailing Address - Street 1:4445 W 16TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7189
Mailing Address - Country:US
Mailing Address - Phone:305-698-2260
Mailing Address - Fax:305-698-2276
Practice Address - Street 1:4445 W 16TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7189
Practice Address - Country:US
Practice Address - Phone:305-698-2260
Practice Address - Fax:305-698-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty