Provider Demographics
NPI:1780888180
Name:DYNAMIC THERAPY CENTER, LLC
Entity type:Organization
Organization Name:DYNAMIC THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KURTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-443-4445
Mailing Address - Street 1:6650 EASTGATE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-6017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6650 EASTGATE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-6017
Practice Address - Country:US
Practice Address - Phone:615-443-4445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66224Z00000X
TN1601224Z00000X
TN1423225100000X
TN1692225X00000X
TN2691235Z00000X
TN3453235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441186Medicaid