MEDICARE: DYNAMIC REHAB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1184182297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC REHAB INC

Provider Business Mailing Address
First Line	:	3120 HAMPSHIRE LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-1207
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7825 S WALKER AVE STE C
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9410
Country	:	US
Telephone Number	:	405-312-8809
Fax Number	:

Authorized Official
Title or Position	:	PT/OWNER
Name	:	CARRIE GALYON
Credential	:
Telephone Number	:	405-312-8809

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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Directions to “DYNAMIC REHAB INC ” Practice Location

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