Dynamic Physical Therapy PLLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

License

PT-1861 Issued in ID

Legal business name

DYNAMIC PHYSICAL THERAPY PLLC

Practice address

1023 21St St
Lewiston, ID 83501-3415

Phone

(208) 743-1795

Fax

(208) 743-1791

NPI assigned

Mar 6, 2015

Organization subpart

No

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

Authorized official

Name

Johanna M Strehle, PTNPI 1528101961

Title

Physical Therapist

Phone

(208) 743-1795

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Johanna Mae Strehle, MPT

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Lewiston, ID
  • NPI 1528101961
  Medicare reassignment Authorized official
• Tara Kazemfar, PT

  • Physical Therapist
  • Lewiston, ID
  • NPI 1356996391
  Medicare reassignment NPD
• Coral Rae Munch, DPT

  • Physical Therapist
  • Lewiston, ID
  • NPI 1902542301
  NPD
• Kaytlin Nelson, PTA

  • Physical Therapy Assistant
  • Lewiston, ID
  • NPI 1932646841
  NPD (past)

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

{
    "created_epoch": "1425600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608508800000",
    "number": "1619360245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 21ST ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835013415",
            "telephone_number": "208-743-1795",
            "fax_number": "208-743-1791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1023 21ST ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835013415",
            "telephone_number": "208-743-1795",
            "fax_number": "208-743-1791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-06",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A",
        "authorized_official_last_name": "STREHLE",
        "authorized_official_first_name": "JOHANNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "208-743-1795",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "ID",
            "license": "PT-1861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith R Drury, PT
• Elaine B Dufford, LCSW
• Kathryn M Duman, LSW
• Nicole M Dwyer, PA
• Timothy J. Dykstra, DO
• Eagle Healthcare Inc
• Eastgate Chiropractic Incorporated
• Cort Eckert, RN
• Christina Edmonson, LCSW
• Madison Ashley Edwards, PHARMD

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.