Healthcare Provider Details

I. General information

NPI: 1205875093
Provider Name (Legal Business Name): DYNAMIC THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date: 12/09/2024
Reactivation Date: 12/19/2024

III. Provider practice location address

632 W STEIN HWY
SEAFORD DE
19973-1204
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-5700
  • Fax: 302-629-6001
Mailing address:
  • Phone: 252-248-3313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUANA GRANADOS
Title or Position: DIRECTORY, CREDENTIALING
Credential:
Phone: 630-575-1980