NPIMap

Organization Active NPI

Dynamic Physical Therapy Center

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Roselle Park, NJ
National Provider Identifier
1386770659
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
DYNAMIC PHYSICAL THERAPY CENTER
Practice address
313 E Westfield Ave
Roselle Park, NJ 07204-2317
Phone
(908) 620-1991
Fax
(908) 620-9777
NPI assigned
Feb 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Shawn Davis A, DPT
Title
Administrator
Phone
(908) 620-1991

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X NU Primary

Addresses

Primary practice location

313 E Westfield Ave
Roselle Park, NJ 07204-2317

Mailing address

313 E Westfield Ave
Roselle Park, NJ 07204-2317
Phone (908) 620-1991

National Provider Directory

National Provider Directory

Locations

313 E Westfield Ave
Roselle Park, NJ 07204
Phone (908) 620-1991

Practitioners & affiliated clinicians

Practitioners 6

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": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386770659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 E WESTFIELD AVE",
            "city": "ROSELLE PARK",
            "state": "NJ",
            "postal_code": "072042317",
            "telephone_number": "908-620-1991",
            "fax_number": "908-620-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 E WESTFIELD AVE",
            "city": "ROSELLE PARK",
            "state": "NJ",
            "postal_code": "072042317",
            "telephone_number": "908-620-1991",
            "fax_number": "908-620-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "A",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "DAVIS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "908-620-1991",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roselle Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.