Healthcare Provider Details

I. General information

NPI: 1962339523
Provider Name (Legal Business Name): M3 DYNAMIC PHYSICAL THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5711 SPRINGFIELD AVE STE B
LAREDO TX
78041-3282
US

IV. Provider business mailing address

5711 SPRINGFIELD AVE STE B
LAREDO TX
78041-3282
US

V. Phone/Fax

Practice location:
  • Phone: 956-236-9395
  • Fax:
Mailing address:
  • Phone: 956-236-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MOUZZAM KAGALWALA
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 956-236-9395