Healthcare Provider Details

I. General information

NPI: 1760704126
Provider Name (Legal Business Name): DYNAMIC HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 LITTLE NECK RD BLDG 3300 SUITE 100
VIRGINIA BEACH VA
23452-5765
US

IV. Provider business mailing address

2254A MAPLE ST
VIRGINIA BEACH VA
23451-1308
US

V. Phone/Fax

Practice location:
  • Phone: 757-639-3153
  • Fax: 757-318-9151
Mailing address:
  • Phone: 757-639-3153
  • Fax: 757-318-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305003917
License Number StateVA

VIII. Authorized Official

Name: DIANE HAUPT
Title or Position: OWNER
Credential: MS, PT
Phone: 757-639-3153