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General NPI Number Information
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NPI Number | 1497090302
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Entity Type | Organization
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Legal Business Name | DYNAMIC PHYSIOTHERAPY SERVICES CORP
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 4601 W 103RD ST
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City | OAK LAWN
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State | IL
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Zip | 60453-4718
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Country | US
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Telephone | 708-422-3422
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S ADAMS ST
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City | WESTMONT
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State | IL
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Zip | 60559-2206
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Country | US
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Telephone | 773-354-3063
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WITOLD MIERZWA
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Credential | LPT
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Telephone | 773-354-3063
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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