Healthcare Provider Details

I. General information

NPI: 1124239363
Provider Name (Legal Business Name): DYNAMIC KIDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N PEACH AVE STE G14
CLOVIS CA
93611-7247
US

IV. Provider business mailing address

755 N PEACH AVE STE G14
CLOVIS CA
93611-7247
US

V. Phone/Fax

Practice location:
  • Phone: 559-433-4700
  • Fax: 559-234-1440
Mailing address:
  • Phone: 559-433-4700
  • Fax: 559-234-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT25969
License Number StateCA

VIII. Authorized Official

Name: MRS. AIMEE JAYNE TIJERINA
Title or Position: DIRECTOR, PHYSICAL THERAPIST
Credential: P.T.
Phone: 559-433-4700