NPIMap

Organization Active NPI

Dynapeak Fitness and Physical Therapy, PC

  • Physical Therapy Clinic/Center
  • Mount Prospect, IL
National Provider Identifier
1033509914
Registry record updated Jan 29, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
070009748 Issued in IL
Legal business name
DYNAPEAK FITNESS AND PHYSICAL THERAPY, PC
Practice address
116 S Hi Lusi Ave
Mount Prospect, IL 60056-3025
Phone
(847) 372-5735
NPI assigned
Jan 29, 2015
Last updated
Jan 29, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2015

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

Authorized official

Name
Dina Petricca, PTNPI 1003084757
Title
Owner/President
Phone
(847) 372-5735

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 070009748 IL Primary

Addresses

Primary practice location

116 S Hi Lusi Ave
Mount Prospect, IL 60056-3025

Mailing address

116 S Hi Lusi Ave
Mount Prospect, IL 60056-3025
Phone (847) 372-5735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160126002857 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9638472582 Receives reassigned benefits from 4 practitioners
Practice locations: Mount Prospect, IL

National Provider Directory

National Provider Directory

Locations

106 S Emerson St
Mt Prospect, IL 60056
Phone (847) 368-1234

701 N Wheeling Rd
Mt Prospect, IL 60056
Phone (224) 801-4348

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422489600000",
    "number": "1033509914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 S HI LUSI AVE",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600563025",
            "telephone_number": "847-372-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 S HI LUSI AVE",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600563025",
            "telephone_number": "847-372-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAPEAK FITNESS AND PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-29",
        "last_updated": "2015-01-29",
        "status": "A",
        "authorized_official_last_name": "PETRICCA",
        "authorized_official_first_name": "DINA",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "847-372-5735",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070009748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Prospect, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.