Healthcare Provider Details

I. General information

NPI: 1487406401
Provider Name (Legal Business Name): DYNAMIC PHYSICAL THERAPY AT HOME FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 ROYAL PALLADIUM PL
BOYNTON BEACH FL
33436-5068
US

IV. Provider business mailing address

220 LIVINGSTON ST STE 108
NORTHVALE NJ
07647-1739
US

V. Phone/Fax

Practice location:
  • Phone: 201-564-7515
  • Fax: 201-564-7514
Mailing address:
  • Phone: 201-564-7515
  • Fax: 201-564-7514

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

VIII. Authorized Official

Name: CHRISTOPHER MERCADO
Title or Position: MANAGING DIRECTOR
Credential: PHYSICAL THERAPIST
Phone: 201-757-0669