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General NPI Number Information
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NPI Number | 1083916787
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Entity Type | Organization
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Legal Business Name | DYNAMIC PEDIATRIC THERAPY, INC.
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 15600 SW 288TH ST STE 202
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City | HOMESTEAD
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State | FL
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Zip | 33033-1200
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Country | US
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Telephone | 305-242-9424
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Fax |
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Provider Business Mailing Address
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Address Line | 3581 NE 11 DR NONE
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City | HOMESTEAD
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State | FL
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Zip | 33033
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Country | US
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Telephone | 954-682-7633
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ILEANA MARTINEZ
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Credential |
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Telephone | 305-242-9424
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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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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | OTA11461
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License Number State | FL
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