| Organization Name: | DYNAMIC PHYSICAL THERAPY CENTER |
| NPI Number: | 1386770659 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAWN DAVIS A (ADMINISTRATOR) |
| Mailing Address: | 313 E Westfield Ave Roselle Park |
| State: | NJ US |
| Postal Code: | 072042317 |
| Phone Number: | 9086201991 |
| Fax Number: | 9086209777 |
| NPI Enumeration Date: | 02/23/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0401X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Taxonomy Definition: | |