MEDICARE: DYNAMIC EDGE PHYSIOTHERAPY MONROE 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1679429815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC EDGE PHYSIOTHERAPY MONROE LLC

Provider Business Mailing Address
First Line	:	396 DANBURY RD UNIT 5
Second Line	:
City	:	WILTON
State	:	CT
Zip	:	06897-2024
Country	:	US
Telephone Number	:	203-978-3343
Fax Number	:

Provider Business Practice Location Address
First Line	:	477 MAIN ST UNIT 13
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-1146
Country	:	US
Telephone Number	:	203-978-3343
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRICK BUCKLEY
Credential	:	DPT
Telephone Number	:	203-978-3343

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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