Healthcare Provider Details

I. General information

NPI: 1942611496
Provider Name (Legal Business Name): DYNAMIC THERAPY SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2014
Last Update Date: 09/23/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 PICARDY AVE
BATON ROUGE LA
70809
US

IV. Provider business mailing address

830 TROUTBECK DR
BATON ROUGE LA
70810-1995
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-5032
  • Fax: 888-531-1703
Mailing address:
  • Phone: 225-767-5032
  • Fax: 888-531-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VICKY ROY
Title or Position: CO-OWNER
Credential: PHD
Phone: 225-767-5032