NPIMap

Organization Active NPI

Dynamic Peak Physical Therapy PT Pta

  • Physical Therapist
  • Rutherford, NJ
National Provider Identifier
1437652476
Registry record updated Jul 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
40QA01300700 Issued in NJ
Legal business name
DYNAMIC PEAK PHYSICAL THERAPY PT PTA
Practice address
75 Orient Way Ste 301
Rutherford, NJ 07070-2086
Phone
(201) 351-3055
Fax
(201) 351-3184
NPI assigned
Mar 15, 2018
Last updated
Jul 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2022

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

Authorized official

Name
Michael Derilo Mirabueno, DPTNPI 1962648170
Title
President
Phone
(732) 407-6308

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X
Acupuncturist 171100000X
Physical Therapist 225100000X 40QA01300700 NJ Primary

Addresses

Primary practice location

75 Orient Way Ste 301
Rutherford, NJ 07070-2086

Mailing address

75 Orient Way Ste 301
Rutherford, NJ 07070-2086
Phone (201) 351-3055

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180702001193 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5698021822 Receives reassigned benefits from 2 practitioners
Practice locations: Rutherford, NJ

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1521072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658448000000",
    "number": "1437652476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 ORIENT WAY STE 301",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070702086",
            "telephone_number": "201-351-3055",
            "fax_number": "201-351-3184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 ORIENT WAY STE 301",
            "city": "RUTHERFORD",
            "state": "NJ",
            "postal_code": "070702086",
            "telephone_number": "201-351-3055",
            "fax_number": "201-351-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PEAK PHYSICAL THERAPY PT PTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-15",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A",
        "authorized_official_last_name": "MIRABUENO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DERILO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-407-6308",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01300700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutherford, NJ

Sources for this page

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