MEDICARE: DYNAMIC BEGINNINGS THERAPY LLC

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1275284739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC BEGINNINGS THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 281
Second Line	:
City	:	BALLENTINE
State	:	SC
Zip	:	29002-0281
Country	:	US
Telephone Number	:	803-422-3894
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 DEER RUN RD
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-8605
Country	:	US
Telephone Number	:	803-422-3894
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHAE PEAK
Credential	:
Telephone Number	:	803-422-3894

Provider Enumeration Date	:	01/15/2022
Last Update Date	:	01/15/2022

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Directions to “DYNAMIC BEGINNINGS THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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