Healthcare Provider Details

I. General information

NPI: 1356086961
Provider Name (Legal Business Name): DYNAMIC MOBILE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 PARKER COMMONS BLVD STE 106
FORT MYERS FL
33912-1973
US

IV. Provider business mailing address

21208 WAYMOUTH RUN
ESTERO FL
33928-3243
US

V. Phone/Fax

Practice location:
  • Phone: 239-361-2890
  • Fax: 239-361-2780
Mailing address:
  • Phone: 239-361-2890
  • Fax: 239-361-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEKAAEL MAHMOUD
Title or Position: CEO
Credential: OTR
Phone: 401-256-9997