Healthcare Provider Details

I. General information

NPI: 1710199336
Provider Name (Legal Business Name): DYNAMIC SENIORS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 ALLEN RD
ZEPHYRHILLS FL
33541-3555
US

IV. Provider business mailing address

4729 ALLEN RD
ZEPHYRHILLS FL
33541-3555
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-8843
  • Fax: 813-782-8843
Mailing address:
  • Phone: 813-782-8843
  • Fax: 813-782-8843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9000
License Number StateFL

VIII. Authorized Official

Name: MS. TERESA LYNN WARMKE
Title or Position: OWNER-ADMINISTRATOR
Credential: OTR-L
Phone: 813-973-8151