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General NPI Number Information
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NPI Number | 1558432732
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPY SOLUTIONS
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 135 WOODLAND AVE
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City | WOODLAND
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State | CA
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Zip | 95695-2701
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Country | US
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Telephone | 530-662-9674
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Fax |
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Provider Business Mailing Address
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Address Line | 4605 W IMPERIAL VIEW CT
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City | ROCKLIN
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State | CA
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Zip | 95677-4492
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Country | US
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Telephone | 916-532-4899
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Fax | 916-625-0626
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. SHAWN MIKEL FITZPATRICK
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Credential | MPT
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Telephone | 916-532-4899
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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 | PT-23166
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License Number State | CA
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