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General NPI Number Information
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NPI Number | 1902983802
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Entity Type | Organization
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Legal Business Name | DYNAMIC PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 10731 W FOREST HOME AVE
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City | HALES CORNERS
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State | WI
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Zip | 53130-2555
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Country | US
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Telephone | 414-529-4605
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Fax |
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Provider Business Mailing Address
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Address Line | 10731 W FOREST HOME AVE
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City | HALES CORNERS
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State | WI
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Zip | 53130-2555
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Country | US
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Telephone | 414-529-4605
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. CHARLES REITZ
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Credential | R.P.T.
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Telephone | 414-529-4605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3307-024
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License Number State | WI
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