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General NPI Number Information
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NPI Number | 1679429815
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Entity Type | Organization
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Legal Business Name | DYNAMIC EDGE PHYSIOTHERAPY MONROE LLC
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 477 MAIN ST UNIT 13
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City | MONROE
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State | CT
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Zip | 06468-1146
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Country | US
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Telephone | 203-978-3343
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Fax |
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Provider Business Mailing Address
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Address Line | 396 DANBURY RD UNIT 5
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City | WILTON
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State | CT
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Zip | 06897-2024
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Country | US
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Telephone | 203-978-3343
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PATRICK BUCKLEY
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Credential | DPT
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Telephone | 203-978-3343
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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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