MEDICARE: DYNAMIC PHYSICAL THERAPY AND SPORTS PERFORMANCE, 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	:	1770958670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC PHYSICAL THERAPY AND SPORTS PERFORMANCE, INC

Provider Business Mailing Address
First Line	:	44651 VILLAGE CT STE 120
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3823
Country	:	US
Telephone Number	:	760-501-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	44651 VILLAGE CT STE 120
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3823
Country	:	US
Telephone Number	:	760-501-6655
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KAREN E. ELBERT
Credential	:	PT, DPT, OCS
Telephone Number	:	515-320-6046

Provider Enumeration Date	:	12/03/2015
Last Update Date	:	02/05/2016

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