Dynamic Edge Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

3061 Issued in OR

Legal business name

DYNAMIC EDGE PHYSICAL THERAPY LLC

Practice address

113 S Main St
113 S. Main
Milton Freewater, OR 97862-1342

Phone

(541) 938-5553

Fax

(541) 938-5554

NPI assigned

Feb 5, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kimberly A Cole, PT

Title

Administrator

Phone

(541) 938-5553

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391558400000",
    "number": "1013331479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 S MAIN ST",
            "address_2": "113 S. MAIN",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978621342",
            "telephone_number": "541-938-5553",
            "fax_number": "541-938-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 S MAIN ST",
            "address_2": "113 S. MAIN",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978621342",
            "telephone_number": "541-938-5553",
            "fax_number": "541-938-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC EDGE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-05",
        "last_updated": "2014-02-05",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "541-938-5553",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OR",
            "license": "3061",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "PT00006939",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE UNSPECIFIED",
            "identifier": "133980",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarke Podiatry, LLC
• Paksupim Cole, L.M.T.
• Mary Cowling
• Elizabeth Johanna Decleene, QMHA
• John Edward Destito, PHARMD
• Edson R Brewer (Northwest Hearing Consultants)
• Dinah Estraza Estrellanes, PT
• Evergreen Oregon Healthcare Orchards Rehabilitation, L.L.C. (Milton Freewater Health and Rehabilitation Center)
• Evergreen Oregon Healthcare Orchards Retirement, L.L.C. (Cascade Valley Assisted Living)
• Fire Inc

• Physical Therapy Clinic/Center in Milton Freewater, OR
• Providers in Milton Freewater, OR by specialty
• Physical Therapy Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.