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General NPI Number Information
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NPI Number | 1649868720
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPY AND WELLNESS LLC
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 221 MAIN ST N
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City | PIERZ
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State | MN
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Zip | 56364-1570
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Country | US
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Telephone | 320-630-2776
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Fax |
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Provider Business Mailing Address
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Address Line | 23749 133RD ST
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City | PIERZ
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State | MN
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Zip | 56364-2556
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Country | US
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Telephone | 320-630-2776
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Fax |
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Authorized Official
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Title or Position | CEO, CFO
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Name | KELSEY ANNE MEYER
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Credential | DPT
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Telephone | 320-630-2776
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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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