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1649868720 NPI number — DYNAMIC THERAPY AND WELLNESS LLC

NPI Number: 1649868720
Health Care Provider/Practitioner: DYNAMIC THERAPY AND WELLNESS LLC

Information about “1649868720” NPI (DYNAMIC THERAPY AND WELLNESS LLC) exists in 1649868720 in HTML format HTML  |  1649868720 in plain Text format TXT  |  1649868720 in PDF (Portable Document Format) PDF  |  1649868720 in an XML format XML  formats.

NPI Number : 1649868720 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1649868720",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DYNAMIC THERAPY AND WELLNESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "23749 133RD ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PIERZ",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "56364-2556",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "320-630-2776",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "221 MAIN ST N",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PIERZ",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "56364-1570",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "320-630-2776",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/05/2021",
    "LastUpdateDate": "01/05/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MEYER",
    "AuthorizedOfficialFirstName": "KELSEY",
    "AuthorizedOfficialMiddleName": "ANNE",
    "AuthorizedOfficialTitle": "CEO, CFO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DPT",
    "AuthorizedOfficialTelephoneNumber": "320-630-2776",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2000X",
        "TaxonomyName": "Physical Therapy Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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