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General NPI Number Information
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NPI Number | 1508555970
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Entity Type | Organization
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Legal Business Name | DYNAMIC ABILITIES PEDIATRIC THERAPY: OCCUPATIONAL AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 950 BOARDWALK STE 204
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City | SAN MARCOS
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State | CA
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Zip | 92078-2600
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Country | US
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Telephone | 760-383-3278
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Fax | 760-502-1474
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Provider Business Mailing Address
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Address Line | 950 BOARDWALK STE 204
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City | SAN MARCOS
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State | CA
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Zip | 92078-2600
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Country | US
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Telephone | 760-383-3278
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CHIEF EXECUTIVE OFFICER
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Name | DONNA MARMOLEJO
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Credential | PT, DPT
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Telephone | 760-383-3278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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