MEDICARE: DYNAMIC THERAPY SERVICES 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	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1528536224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC THERAPY SERVICES LLC

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	191-925-8271
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 VIRGINIA DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3203
Country	:	US
Telephone Number	:	919-258-2714
Fax Number	:

Authorized Official
Title or Position	:	DRCM
Name	:	PENNY PEARSON
Credential	:
Telephone Number	:	443-225-4492

Provider Enumeration Date	:	11/12/2018
Last Update Date	:	01/22/2020

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Directions to “DYNAMIC THERAPY SERVICES LLC ” Practice Location

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