Provider Demographics
NPI:1932664844
Name:DYNAMIC ORTHOPEDIC PHYSICAL THERAPY WELLNESS CLINIC, LLC
Entity Type:Organization
Organization Name:DYNAMIC ORTHOPEDIC PHYSICAL THERAPY WELLNESS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ADOLFO
Authorized Official - Last Name:ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:361-354-4274
Mailing Address - Street 1:6014 QUEEN BESS DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4068
Mailing Address - Country:US
Mailing Address - Phone:361-354-4274
Mailing Address - Fax:800-784-2040
Practice Address - Street 1:9929 S PADRE ISLAND DR STE 117
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-5148
Practice Address - Country:US
Practice Address - Phone:361-657-0168
Practice Address - Fax:800-784-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty