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General NPI Number Information
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NPI Number | 1437489796
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Entity Type | Organization
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Legal Business Name | DYNAMIX REHABILITATION SERVICES, INC.
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Dates
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Enumeration Date | 01/10/2010
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Last Update Date | 01/10/2010
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Provider Practice Location Address
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Address Line | 3206 RFD
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City | LONG GROVE
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State | IL
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Zip | 60047-8352
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Country | US
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Telephone | 847-452-3403
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Fax | 847-745-0546
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Provider Business Mailing Address
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Address Line | 3206 RFD
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City | LONG GROVE
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State | IL
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Zip | 60047-8352
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Country | US
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Telephone | 847-452-3403
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Fax | 847-745-0546
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARINA ARDASHNIKOVA
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Credential | M.D.
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Telephone | 847-736-9254
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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 | 070013646
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License Number State | IL
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