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General NPI Number Information
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NPI Number | 1194094839
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Entity Type | Organization
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Legal Business Name | DYNAMIC CARE OT, PT, SLP PLLC
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 05/11/2013
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Provider Practice Location Address
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Address Line | 7540 AUSTIN ST 3GR
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City | FOREST HILLS
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State | NY
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Zip | 11375-6248
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Country | US
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Telephone | 718-286-9212
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Fax |
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Provider Business Mailing Address
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Address Line | 7540 AUSTIN ST 3GR
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City | FOREST HILLS
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State | NY
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Zip | 11375-6248
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Country | US
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Telephone | 718-286-9212
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. JOSE DAVILA
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Credential | PT,MPH
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Telephone | 718-286-9212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 021147
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License Number State | NY
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