| Organization Name: | DYNAMIC PHYSICAL THERAPY LLC |
| NPI Number: | 1932595691 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW S NELSON (PHYSICAL THERAPIST) |
| Mailing Address: | 1265 E Fort Union Blvd Ste 110 Cottonwood Heights |
| State: | UT US |
| Postal Code: | 840471807 |
| Phone Number: | 8014501881 |
| Fax Number: | |
| NPI Enumeration Date: | 04/09/2015 |
| NPI Last Update Date: | 07/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 9321575-0160 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |