MEDICARE: DYNAMIC PT AND REHAB 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	225100000X	Physical Therapist	HCC8564	FL

General Provider Information

NPI Number	:	1982938817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC PT AND REHAB LLC

Provider Business Mailing Address
First Line	:	8136 OKEECHOBEE BLVD
Second Line	:	SUITE A & B
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2002
Country	:	US
Telephone Number	:	156-116-9633
Fax Number	:	156-161-6932

Provider Business Practice Location Address
First Line	:	8136 OKEECHOBEE BLVD
Second Line	:	SUITE A & B
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2002
Country	:	US
Telephone Number	:	156-116-9633
Fax Number	:	156-161-6932

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	MR. OLEG RUBIN
Credential	:
Telephone Number	:	201-819-4348

Provider Enumeration Date	:	09/24/2009
Last Update Date	:	09/24/2009

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Directions to “DYNAMIC PT AND REHAB LLC ” Practice Location

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