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General NPI Number Information
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NPI Number | 1306039334
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPY CONCEPTS PLLC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 245 JENNIFER LYNN DR
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City | PADUCAH
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State | KY
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Zip | 42001-4861
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Country | US
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Telephone | 270-705-5898
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Fax |
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Provider Business Mailing Address
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Address Line | 245 JENNIFER LYNN DR
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City | PADUCAH
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State | KY
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Zip | 42001-4861
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Country | US
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Telephone | 270-705-5898
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | DR. MARY LISA HALL
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Credential | PT, DPT
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Telephone | 270-705-5898
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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 | 002256
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License Number State | KY
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