NPIMap

Organization Active NPI

Dynamic Physical Therapy and Sports Rehabilitations

  • Physical Therapy Clinic/Center
  • Northvale, NJ
National Provider Identifier
1891017034
Registry record updated Mar 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
DYNAMIC PHYSICAL THERAPY AND SPORTS REHABILITATIONS
Practice address
220 Livingston St
Suite 112
Northvale, NJ 07647-1738
Phone
(201) 564-7515
NPI assigned
Feb 15, 2010
Last updated
Mar 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2014

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

Authorized official

Name
Christopher Mercado, PTNPI 1619024122
Title
Physical Therapist, Owner
Phone
(201) 757-0669

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary
Chiropractor 111N00000X NU

Addresses

Primary practice location

220 Livingston St
Suite 112
Northvale, NJ 07647-1738

Mailing address

220 Livingston St
Suite 112
Northvale, NJ 07647-1738
Phone (201) 757-0669

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100513001007 NJ Part B Supplier - Clinic/Group Practice 0042348948 Receives reassigned benefits from 7 practitioners
Practice locations: Northvale, NJ

National Provider Directory

National Provider Directory

Locations

220 Livingston St
Ste 112
Northvale, NJ 07647
Phone (201) 564-7515

Practitioners & affiliated clinicians

Practitioners 11

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": "1266192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394755200000",
    "number": "1891017034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 LIVINGSTON ST",
            "address_2": "SUITE 112",
            "city": "NORTHVALE",
            "state": "NJ",
            "postal_code": "076471738",
            "telephone_number": "201-757-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 LIVINGSTON ST",
            "address_2": "SUITE 112",
            "city": "NORTHVALE",
            "state": "NJ",
            "postal_code": "076471738",
            "telephone_number": "201-564-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY AND SPORTS REHABILITATIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-15",
        "last_updated": "2014-03-14",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "201-757-0669",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northvale, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; 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.