Organization Active NPI

Dynamic Pain & Wellness LLC

  • Pain Medicine Physician
  • Mobile, AL
National Provider Identifier
1386123560
Registry record updated May 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
DYNAMIC PAIN & WELLNESS LLC
Practice address
4724 Airport Blvd
Mobile, AL 36608-3134
Phone
(850) 226-6801
Fax
(877) 413-5104
NPI assigned
Aug 9, 2018
Last updated
May 15, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
DYNAMIC PAIN & WELLNESS PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2026

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

Authorized official

Name
Trista Elliott
Title
Credentialing
Phone
(850) 226-6801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

4724 Airport Blvd
Mobile, AL 36608-3134

Mailing address

930 Mar Walt Drive
Fort Walton Beach, FL 32547
Phone (850) 226-6801

National Provider Directory

National Provider Directory
Part of
Dynamic Pain Wellness LLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778803200000",
    "number": "1386123560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 MAR WALT DRIVE",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "32547",
            "telephone_number": "850-226-6801",
            "fax_number": "877-413-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4724 AIRPORT BLVD",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366083134",
            "telephone_number": "850-226-6801",
            "fax_number": "877-413-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PAIN & WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DYNAMIC PAIN & WELLNESS PLLC",
        "enumeration_date": "2018-08-09",
        "last_updated": "2026-05-15",
        "certification_date": "2026-05-15",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "TRISTA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "850-226-6801"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2026; 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.