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General NPI Number Information
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NPI Number | 1316016801
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPY INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 4734 EXPLORATION AVE
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City | LAKELAND
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State | FL
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Zip | 33812-3319
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Country | US
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Telephone | 863-648-2333
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Fax | 863-648-2888
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Provider Business Mailing Address
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Address Line | 4734 EXPLORATION AVE
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City | LAKELAND
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State | FL
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Zip | 33812-3319
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Country | US
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Telephone | 863-648-2333
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Fax | 863-648-2888
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MRS. BERNADETTE CHUA OCAMPOS
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Credential | RPT
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Telephone | 863-648-2333
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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 | PT10695
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License Number State | FL
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