Provider Demographics
NPI:1780781971
Name:DYNAMIC PHYSICAL THERAPY AND HAND CENTER, LLC
Entity type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY AND HAND CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:304-720-5433
Mailing Address - Street 1:6 COURTNEY DR
Mailing Address - Street 2:SEDGLEY OFFICE PARK
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2696
Mailing Address - Country:US
Mailing Address - Phone:304-720-5433
Mailing Address - Fax:304-720-5436
Practice Address - Street 1:6 COURTNEY DR
Practice Address - Street 2:SEDGLEY OFFICE PARK
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2696
Practice Address - Country:US
Practice Address - Phone:304-720-5433
Practice Address - Fax:304-720-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004533Medicaid
WV4941580001Medicare NSC
WV9337391Medicare PIN