Provider Demographics
NPI:1811065071
Name:DYNAMIC REHABILITATION SERVICES
Entity type:Organization
Organization Name:DYNAMIC REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:DOLLY
Authorized Official - Last Name:PHADKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:219-476-0377
Mailing Address - Street 1:2102 E EVANS AVE
Mailing Address - Street 2:#115
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4096
Mailing Address - Country:US
Mailing Address - Phone:219-476-0377
Mailing Address - Fax:219-476-0388
Practice Address - Street 1:2102 E EVANS AVE
Practice Address - Street 2:#115
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4096
Practice Address - Country:US
Practice Address - Phone:219-476-0377
Practice Address - Fax:219-476-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCG7971OtherPALMETTO RR MEDICARE
IN148240Medicare ID - Type Unspecified