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General NPI Number Information
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NPI Number | 1700221371
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Entity Type | Organization
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Legal Business Name | DYNAMIC HEALTH PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 09/04/2019
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Provider Practice Location Address
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Address Line | 35 TOWER LANE SUITE 110
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City | AVON
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State | CT
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Zip | 06001-4237
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Country | US
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Telephone | 860-404-2549
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Fax | 860-404-2621
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Provider Business Mailing Address
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Address Line | 35 TOWER LANE SUITE 110
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City | AVON
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State | CT
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Zip | 06001-4237
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Country | US
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Telephone | 860-404-2549
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Fax | 860-404-2621
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | MR. CHRISTOPHER ROBERTS
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Credential | P.T.
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Telephone | 860-930-4924
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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 | 006036
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License Number State | CT
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