Healthcare Provider Details

I. General information

NPI: 1669619268
Provider Name (Legal Business Name): DYNAMIX PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 RHINO XING
MILAN TN
38358-5201
US

IV. Provider business mailing address

PO BOX 1004
MILAN TN
38358-1004
US

V. Phone/Fax

Practice location:
  • Phone: 731-613-2214
  • Fax: 731-613-2215
Mailing address:
  • Phone: 731-613-2214
  • Fax: 731-613-2215

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. RUSS ALEXANDER HUFFSTETLER
Title or Position: OWNER
Credential: PT
Phone: 731-613-2214