Healthcare Provider Details

I. General information

NPI: 1366536864
Provider Name (Legal Business Name): DYNAMIC THERAPY & WELLNESS SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13795 SW 36TH AVENUE RD STE 1
OCALA FL
34473-6104
US

IV. Provider business mailing address

13795 SW 36TH AVENUE RD STE 1
OCALA FL
34473-6104
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-9251
  • Fax: 833-892-0509
Mailing address:
  • Phone: 352-693-5367
  • Fax: 833-892-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STELLA H. NEMUSESO
Title or Position: PRESIDENT/DIRECTOR
Credential: DPT
Phone: 352-414-9251