Healthcare Provider Details

I. General information

NPI: 1770994873
Provider Name (Legal Business Name): DYNAMIC REHAB PHYSICAL THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 W AVENUE L
LANCASTER CA
93534-8827
US

IV. Provider business mailing address

45714 KAASTAD CT
LANCASTER CA
93534-5105
US

V. Phone/Fax

Practice location:
  • Phone: 661-948-1999
  • Fax: 661-948-6699
Mailing address:
  • Phone: 661-948-1999
  • Fax: 661-948-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17853
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT17853
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT17853
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT17853
License Number StateCA

VIII. Authorized Official

Name: MR. FRANCISCO MARTINEZ
Title or Position: OWNER/THERAPIST
Credential: PT
Phone: 661-948-1999