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NPI Code Detail

MEDICARE: DYNAMIC PHYSICAL THERAPY, INC.

MEDICARE: DYNAMIC PHYSICAL THERAPY, INC.
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
1261QR0400XRehabilitation Clinic/Center

General Provider Information

NPI Number : 1962974824
Entity Type Code : Organization
Provider Name (Legal Business Name) : DYNAMIC PHYSICAL THERAPY, INC.
Provider Business Mailing Address
First Line : PO BOX 150
Second Line :
City : LIMA
State : OH
Zip : 45802-0150
Country : US
Telephone Number : 419-221-6717
Fax Number : 419-222-0507
Provider Business Practice Location Address
First Line : 2316 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7760
Country : US
Telephone Number : 312-739-3030
Fax Number : 866-221-3400
Authorized Official
Title or Position : EXECUTIVE VICE PRESIDENT
Name : MR. STEPHEN KRZYMINSKI
Credential :
Telephone Number : 419-221-6717
Provider Enumeration Date : 12/17/2018
Last Update Date : 10/24/2023

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