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General NPI Number Information
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NPI Number | 1326294349
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Entity Type | Organization
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Legal Business Name | DYNAMIC PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 25 N CASS AVE
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City | WESTMONT
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State | IL
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Zip | 60559-1601
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Country | US
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Telephone | 630-615-9170
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Fax | 630-493-0995
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Provider Business Mailing Address
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Address Line | 440 E ROOSEVELT RD UNIT 104
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City | WEST CHICAGO
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State | IL
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Zip | 60185-3902
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Country | US
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Telephone | 630-876-9186
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Fax | 630-876-9187
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | ROBIN L POWERS
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Credential |
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Telephone | 630-876-9186
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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 | 070.008757
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License Number State | IL
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