Dynamic Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

004925 Issued in CT

Legal business name

DYNAMIC PHYSICAL THERAPY LLC

Practice address

158 South Broad Street
Pawcatuck, CT 06379-1925

Phone

(860) 599-0819

Fax

(860) 599-0871

NPI assigned

Aug 1, 2007

Last updated

Dec 7, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Elizabeth E. Gross, P.T.NPI 1104881812

Title

Owner/Physical Therapist

Phone

(860) 599-0819

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Practitioners 2

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.

• Elizabeth Gross, PT

  • Physical Therapist
  • Pawcatuck, CT
  • NPI 1104881812
  Medicare reassignment NPD Authorized official
• Mary Sue Agostini, PT

  • Physical Therapist
  • Pawcatuck, CT
  • NPI 1790746295
  NPD (past)

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512604800000",
    "number": "1861682296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 SOUTH BROAD STREET",
            "city": "PAWCATUCK",
            "state": "CT",
            "postal_code": "063791925",
            "telephone_number": "860-599-0819",
            "fax_number": "860-599-0871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 SOUTH BROAD STREET",
            "city": "PAWCATUCK",
            "state": "CT",
            "postal_code": "063791925",
            "telephone_number": "860-599-0819",
            "fax_number": "860-599-0871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-01",
        "last_updated": "2017-12-07",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "860-599-0819",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CT",
            "license": "004925",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Child and Family Agency of Southeastern Connecticut, Inc. (Stonington High School)
• Mary Chutjian, LCSW
• Clarisse D. Clemons Ferrara, MD
• Sean Andrew Colsen, DPM
• Vickie Lou Cummings, MS
• Mercy Etzel, RN
• Kristen Fernandez, RN
• John Michael Flaherty, DC
• Golden Heart Care Services LLC
• Abrielle Gouvin

• Physical Therapy Clinic/Center in Pawcatuck, CT
• Providers in Pawcatuck, CT by specialty
• Physical Therapy Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; 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.