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General NPI Number Information
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NPI Number | 1841075223
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Entity Type | Organization
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Legal Business Name | DYNAMIC MOBILITY: MOBILE PEDIATRIC PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 17003 NW 255TH TERRACE
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City | HIGHT SPRINGS
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State | FL
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Zip | 32643
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Country | US
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Telephone | 386-689-3489
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Fax |
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Provider Business Mailing Address
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Address Line | 17003 NW 255TH TERRACE
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City | HIGHT SPRINGS
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State | FL
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Zip | 32643
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Country | US
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Telephone | 386-689-3489
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Fax |
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Authorized Official
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Title or Position | PT/PRESIDENT/OWNER
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Name | AMANDA LYNN GUEVARA
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Credential | PT, OPT
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Telephone | 386-689-3489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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