Healthcare Provider Details

I. General information

NPI: 1285007989
Provider Name (Legal Business Name): DYNAMIC PAIN & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 01/24/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MARWALT DR, UNIT C
FORT WALTON BEACH FL
32547-6706
US

IV. Provider business mailing address

930 MARWALT DRIVE SUITE B AND C
FORT WALTON BEACH FL
32547
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6801
  • Fax: 877-413-5104
Mailing address:
  • Phone: 850-226-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATHEW MCCUNE
Title or Position: CEO
Credential: MD
Phone: 850-502-3310