NPIMap

Organization Active NPI

Dynamic PT LLC

  • Physical Therapist
  • Onalaska, WI
National Provider Identifier
1245948389
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
DYNAMIC PT LLC
Practice address
1430 Main St
Onalaska, WI 54650-2835
Phone
(608) 351-3049
NPI assigned
Nov 8, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Dr. Matt Haberl, DPT
Title
Physical Therapist
Phone
(608) 406-6335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1430 Main St
Onalaska, WI 54650-2835

Mailing address

1430 Main St
Onalaska, WI 54650-2835

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230503001644 WI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3779948302 Receives reassigned benefits from 10 practitioners
Practice locations: La Crosse, WI; Onalaska, WI

National Provider Directory

National Provider Directory

Locations

125 7th St N
Ste B
La Crosse, WI 54601
Phone (608) 351-3049

Practitioners & affiliated clinicians

Practitioners 11

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": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1245948389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 MAIN ST",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546502835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 MAIN ST",
            "city": "ONALASKA",
            "state": "WI",
            "postal_code": "546502835",
            "telephone_number": "608-351-3049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "HABERL",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "608-406-6335",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Onalaska, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.