MEDICARE: DYNAMIC PHYSICAL THERAPY SERVICES 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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1255646956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC PHYSICAL THERAPY SERVICES INC

Provider Business Mailing Address
First Line	:	5740 OLD CHENEY HWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3525
Country	:	US
Telephone Number	:	407-601-4902
Fax Number	:	407-601-6977

Provider Business Practice Location Address
First Line	:	5740 OLD CHENEY HWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3525
Country	:	US
Telephone Number	:	407-601-4902
Fax Number	:	407-601-6977

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JESUS E ALFONSO
Credential	:
Telephone Number	:	786-287-5041

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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