=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356597868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DYNAMIC PHYSICAL THERAPY MANAGEMENT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2008
-----------------------------------------------------
Last Update Date | 08/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 440 E ROOSEVELT RD UNIT 104
-----------------------------------------------------
City | WEST CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60185-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-876-9186
-----------------------------------------------------
Fax | 630-876-9187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 E. ROOSEVELT ROAD UNIT 104
-----------------------------------------------------
City | WEST CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60185-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-876-9186
-----------------------------------------------------
Fax | 630-876-9187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | APRIL L OURY
-----------------------------------------------------
Credential | PT,MS,CFMT
-----------------------------------------------------
Telephone | 630-876-9186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 070.010098
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------