MEDICARE: DYNAMIC KIDS PHYSICAL THERAPY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1447906078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC KIDS PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	PO BOX 7
Second Line	:
City	:	HOLLY RIDGE
State	:	NC
Zip	:	28445-0007
Country	:	US
Telephone Number	:	585-203-2492
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 N TOPSAIL DR UNIT 14
Second Line	:
City	:	SURF CITY
State	:	NC
Zip	:	28445-8814
Country	:	US
Telephone Number	:	585-203-2492
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	CLAIRE GUY
Credential	:	PT, DPT
Telephone Number	:	585-203-2492

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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