Healthcare Provider Details

I. General information

NPI: 1053755041
Provider Name (Legal Business Name): DYNAMX PHYSICAL THERAPY, INC. A PHYSICAL THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7941 BEACH BLVD. SUITE J
BUANA PARK CA
90620-1900
US

IV. Provider business mailing address

333 E GLENOAKS BLVD SUITE 204
GLENDALE CA
91207-2074
US

V. Phone/Fax

Practice location:
  • Phone: 714-736-6855
  • Fax: 714-736-6824
Mailing address:
  • Phone: 818-244-5656
  • Fax: 818-244-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number14473
License Number StateCA

VIII. Authorized Official

Name: MR. NATHANIEL GLENN DABATOS
Title or Position: PRESIDENT
Credential: PT
Phone: 818-244-5656