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General NPI Number Information
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NPI Number | 1386030062
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Entity Type | Organization
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Legal Business Name | DYNAKINETICS PT PC
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 11605 MYRTLE AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-1749
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Country | US
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Telephone | 718-850-7100
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Fax | 718-850-7200
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Provider Business Mailing Address
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Address Line | 8431 VAN WYCK EXPY APT 3J
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City | BRIARWOOD
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State | NY
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Zip | 11435-2611
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Country | US
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Telephone | 917-645-3620
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. VINCENT ANDRY M VILLANUEVA
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Credential | DPT
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Telephone | 917-645-3620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 031185
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License Number State | NY
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