NPIMap

Organization Active NPI

Dynamic Development, LLC

  • Pediatric Physical Therapist
  • Florence, SC
National Provider Identifier
1700079977
Registry record updated Aug 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
2106 Issued in SC
Legal business name
DYNAMIC DEVELOPMENT, LLC
Practice address
2461 S Hallmark Dr
Florence, SC 29505-3911
Phone
(843) 230-2715
Fax
(843) 662-1236
NPI assigned
Aug 21, 2007
Last updated
Aug 21, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2007

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

Authorized official

Name
Shannon Michelle WyontNPI 1528168853
Title
President
Phone
(843) 230-2715

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X 2106 SC Primary

Addresses

Primary practice location

2461 S Hallmark Dr
Florence, SC 29505-3911

Mailing address

2461 S Hallmark Dr
Florence, SC 29505-3911
Phone (843) 230-2715

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201030001139 SC Part B Supplier - Clinic/Group Practice 1759791841 Receives reassigned benefits from 2 practitioners
Practice locations: Florence, SC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187654400000",
    "number": "1700079977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2461 S HALLMARK DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295053911",
            "telephone_number": "843-230-2715",
            "fax_number": "843-662-1236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2461 S HALLMARK DR",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295053911",
            "telephone_number": "843-230-2715",
            "fax_number": "843-662-1236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC DEVELOPMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2007-08-21",
        "status": "A",
        "authorized_official_last_name": "WYONT",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-230-2715"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "SC",
            "license": "2106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2007; 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.