MEDICARE: DYNAMIC THERAPY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750920278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC THERAPY

Provider Business Mailing Address
First Line	:	2599 OAK ST
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3026
Country	:	US
Telephone Number	:	404-576-8145
Fax Number	:	678-515-4149

Provider Business Practice Location Address
First Line	:	2599 OAK ST
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3026
Country	:	US
Telephone Number	:	202-743-3748
Fax Number	:

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MR. DARIUS LARON THOMAS
Credential	:	CCC-SLP
Telephone Number	:	404-576-8145

Provider Enumeration Date	:	01/01/2020
Last Update Date	:	11/26/2022

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Directions to “DYNAMIC THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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