Provider Demographics
NPI:1053598037
Name:DYNAMIC PHYSICAL THERAPY & REHAB SERVICES P.C
Entity type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY & REHAB SERVICES P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEETAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-567-6312
Mailing Address - Street 1:3 SCHOOL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2548
Mailing Address - Country:US
Mailing Address - Phone:516-567-6312
Mailing Address - Fax:516-283-0258
Practice Address - Street 1:3 SCHOOL ST STE 204
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2548
Practice Address - Country:US
Practice Address - Phone:516-567-6312
Practice Address - Fax:516-283-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014812174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2923164Medicaid
NY2923164Medicaid