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General NPI Number Information
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NPI Number | 1720327828
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Entity Type | Organization
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Legal Business Name | DYNAMIC THERAPY 101. L.L.C.
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 2017 NASSAU DR.
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City | RIVIERA BEACH
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State | FL
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Zip | 33404
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Country | US
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Telephone | 561-961-8588
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Fax | 561-623-5577
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Provider Business Mailing Address
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Address Line | 2017 NASSAU DR
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-6460
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Country | US
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Telephone | 561-951-8588
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Fax | 561-623-5577
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. DALE SEVERSON
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Credential |
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Telephone | 561-951-8588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State | FL
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