Healthcare Provider Details

I. General information

NPI: 1871146555
Provider Name (Legal Business Name): DYNAMIC PAIN & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924K DAUPHIN ISLAND PKWY
MOBILE AL
36605-3004
US

IV. Provider business mailing address

1924K DAUPHIN ISLAND PKWY
MOBILE AL
36605-3004
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6801
  • Fax: 877-413-5104
Mailing address:
  • Phone: 850-226-6801
  • Fax: 877-413-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH BAILEY
Title or Position: CREDENTIALING
Credential:
Phone: 850-226-6801