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General NPI Number Information
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NPI Number | 1124239363
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Entity Type | Organization
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Legal Business Name | DYNAMIC KIDS, INC.
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Dates
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Enumeration Date | 05/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 755 N PEACH AVE STE G14
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City | CLOVIS
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State | CA
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Zip | 93611-7247
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Country | US
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Telephone | 559-433-4700
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Fax | 559-234-1440
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Provider Business Mailing Address
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Address Line | 755 N PEACH AVE STE G14
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City | CLOVIS
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State | CA
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Zip | 93611-7247
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Country | US
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Telephone | 559-433-4700
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Fax | 559-234-1440
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Authorized Official
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Title or Position | DIRECTOR, PHYSICAL THERAPIST
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Name | MRS. AIMEE JAYNE TIJERINA
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Credential | P.T.
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Telephone | 559-433-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT25969
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License Number State | CA
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