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General NPI Number Information
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NPI Number | 1083131502
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPY SERVICES LLC
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 550 STANTON CHRISTIANA RD STE 203
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City | NEWARK
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State | DE
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Zip | 19713-2125
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Country | US
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Telephone | 302-691-5603
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Fax | 302-691-5623
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Provider Business Mailing Address
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Address Line | 2122 YORK RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-1925
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Country | US
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Telephone | 252-248-3313
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Fax |
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Authorized Official
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Title or Position | MANAGER, CREDENTIALING
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Name | TASHEDA BROUGHTON
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Credential | PESC
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Telephone | 252-248-3313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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