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General NPI Number Information
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NPI Number | 1275114605
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Entity Type | Organization
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Legal Business Name | DYNAMIC MOTION REHAB INC
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Dates
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Enumeration Date | 04/17/2021
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 883 CRYSTAL LAKE DR
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-1948
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Country | US
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Telephone | 786-312-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 883 CRYSTAL LAKE DR
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City | DEERFIELD BEACH
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State | FL
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Zip | 33064-1948
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Country | US
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Telephone | 786-312-5827
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANA MARCELA ROLDAN MORA
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Credential | ITDS
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Telephone | 786-312-5827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental 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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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