1942337332 NPI number — DYNAMIC MOVEMENT PHYSICAL THERAPY INC

Table of content: (NPI 1942337332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942337332 NPI number — DYNAMIC MOVEMENT PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DYNAMIC MOVEMENT PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DYNAMIC MOVEMENT INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942337332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 61210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-322-5711
Provider Business Mailing Address Fax Number:
775-825-5576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7485 LONGLEY LN
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-852-9995
Provider Business Practice Location Address Fax Number:
775-853-2828
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MONTAGNE
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
ANNETTE
Authorized Official Title or Position:
OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
775-322-5711

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0614 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225200000X , with the licence number: A0357 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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