Dynamic Therapy Concepts PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

002256 Issued in KY

Legal business name

DYNAMIC THERAPY CONCEPTS PLLC

Practice address

245 Jennifer Lynn Dr
Paducah, KY 42001-4861

Phone

(270) 705-5898

NPI assigned

Aug 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mary Lisa Hall, PT, DPT

Title

Doctor of Physical Therapy

Phone

(270) 705-5898

Specialties & licenses 1

Addresses

Other identifiers 7

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524700800000",
    "number": "1306039334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 JENNIFER LYNN DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420014861",
            "telephone_number": "270-705-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 JENNIFER LYNN DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420014861",
            "telephone_number": "270-705-5898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC THERAPY CONCEPTS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2018-04-26",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LISA",
        "authorized_official_title_or_position": "DOCTOR OF PHYSICAL THERAPY",
        "authorized_official_telephone_number": "270-705-5898",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "002256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "00454",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR - PTAN",
            "identifier": "P00435045",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1033121868",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11856022",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR - GROUP",
            "identifier": "DG4266",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100057690",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC & BS",
            "identifier": "000000551156",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Paducah, KY
• Providers in Paducah, KY by specialty
• Physical Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2018; 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.