MEDICARE: DYNAMIC INJURY SOLUTIONS, 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1497389969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC INJURY SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	301 E CITY AVE # LL1
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1708
Country	:	US
Telephone Number	:	215-473-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2487 GRANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1004
Country	:	US
Telephone Number	:	215-462-0150
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	GEORGE L RODRIGUEZ
Credential	:	MD
Telephone Number	:	215-432-4488

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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