Basic Information
| Provider Information | |||||||||
| NPI: | 1497122295 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DYNAMIC THERAPY SERVICES LLC | ||||||||
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| OtherOrganizationName: | PIVOT PHYSICAL THERAPY OF MID ATLANTIC, LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 NEW FIDELITY CT | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275292665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192582714 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 ELKTON BLVD STE 4 | ||||||||
| Address2: | |||||||||
| City: | ELKTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219215323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4433509056 | ||||||||
| FaxNumber: | 4433509565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2015 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| AuthorizedOfficialLastName: | PEARSON | ||||||||
| AuthorizedOfficialFirstName: | PENNY | ||||||||
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| AuthorizedOfficialTitleorPosition: | RCM | ||||||||
| AuthorizedOfficialTelephone: | 9192582714 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.