Healthcare Provider Details

I. General information

NPI: 1295349413
Provider Name (Legal Business Name): DYNAMIC PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 N UNION BLVD
COLORADO SPRINGS CO
80918-1744
US

IV. Provider business mailing address

5775 N UNION BLVD
COLORADO SPRINGS CO
80918-1744
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-7044
  • Fax: 719-375-1276
Mailing address:
  • Phone: 719-434-7044
  • Fax: 719-375-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STACEY WELFEL
Title or Position: PRESIDENT
Credential: PT
Phone: 719-434-7044