Provider Demographics
NPI:1053755041
Name:DYNAMX PHYSICAL THERAPY, INC. A PHYSICAL THERAPY CORPORATION
Entity type:Organization
Organization Name:DYNAMX PHYSICAL THERAPY, INC. A PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:DABATOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:818-244-5656
Mailing Address - Street 1:333 E GLENOAKS BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2074
Mailing Address - Country:US
Mailing Address - Phone:818-244-5656
Mailing Address - Fax:818-244-1102
Practice Address - Street 1:7941 BEACH BLVD.
Practice Address - Street 2:SUITE J
Practice Address - City:BUANA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1900
Practice Address - Country:US
Practice Address - Phone:714-736-6855
Practice Address - Fax:714-736-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14473261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy