Healthcare Provider Details

I. General information

NPI: 1811065071
Provider Name (Legal Business Name): DYNAMIC REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 E EVANS AVE #115
VALPARAISO IN
46383-4096
US

IV. Provider business mailing address

2102 E EVANS AVE #115
VALPARAISO IN
46383-4096
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-0377
  • Fax: 219-476-0388
Mailing address:
  • Phone: 219-476-0377
  • Fax: 219-476-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SATISH DOLLY PHADKE
Title or Position: CO OWNER
Credential: PT
Phone: 219-476-0377