| Organization Name: | DYNAMIC EDGE PHYSICAL THERAPY LLC |
| NPI Number: | 1013331479 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KIMBERLY A COLE (ADMINISTRATOR) |
| Mailing Address: | 113 S Main St 113 S. Main Milton Freewater |
| State: | OR US |
| Postal Code: | 978621342 |
| Phone Number: | 5419385553 |
| Fax Number: | 5419385554 |
| NPI Enumeration Date: | 02/05/2014 |
| NPI Last Update Date: | 02/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT00006939 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |