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General NPI Number Information
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NPI Number | 1215085410
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Entity Type | Organization
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Legal Business Name | DYNAMIC PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2506 ACORN ST SUITE B
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City | FORT PIERCE
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State | FL
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Zip | 34947-4750
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Country | US
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Telephone | 772-971-2610
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Fax | 772-879-3483
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Provider Business Mailing Address
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Address Line | 2506 ACORN ST SUITE B
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City | FORT PIERCE
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State | FL
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Zip | 34947-4750
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Country | US
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Telephone | 772-971-2610
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Fax | 772-879-3483
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. MARIA EUGENIA ACEVEDO
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Credential | PT
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Telephone | 772-971-2610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT0011057
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License Number State | FL
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