Dynamic Physical Therapy, Inc.

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

DYNAMIC PHYSICAL THERAPY, INC.

Doing business as

Body Gears - Wheaton

Practice address

400 S County Farm Rd Ste 310
Wheaton, IL 60187-4547

Phone

(630) 937-3030

Fax

(866) 221-3400

NPI assigned

Dec 17, 2018

Last updated

May 21, 2019By 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

Mr. Brad C Roush

Title

Executive Vice President

Phone

(419) 221-6710

Specialties & licenses 1

Addresses

Other names 1

• Body Gears - Wheaton Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952873812. Details of each certification follow.

• CCN 146761 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 146761

Legal name

BODY GEARS - WHEATON

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Oct 23, 2019

Last certification

Oct 23, 2019

Ownership / control type

Proprietary

Facility address

400 S County Farm Road, Suite 310
Wheaton, IL 60187

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Dynamic Physical Therapy

  dba Body Gears - Oak Brook

  • Rehabilitation Clinic/Center
  • Oak Brook, IL
  • NPI 1457609620

  O20190425000933

  Same enrollment
• Dynamic Physical Therapy, Inc.

  dba Body Gears - Oak Park

  • Rehabilitation Clinic/Center
  • Oak Park, IL
  • NPI 1316419278

  O20190425000933

  Same enrollment
• Dynamic Physical Therapy, Inc.

  dba Body Gears - Winnetka

  • Rehabilitation Clinic/Center
  • Winnetka, IL
  • NPI 1881166650

  O20190425000933

  Same enrollment
• Dynamic Physical Therapy, Inc.

  dba Body Gears - West Loop

  • Rehabilitation Clinic/Center
  • Chicago, IL
  • NPI 1891714077

  O20190425000933

  Same enrollment
• Dynamic Physical Therapy, Inc.

  dba Body Gears - Lincoln Park

  • Rehabilitation Clinic/Center
  • Chicago, IL
  • NPI 1962974824

  O20190425000933

  Same enrollment

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558396800000",
    "number": "1952873812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 SHAWNEE RD",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458053529",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S COUNTY FARM RD STE 310",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601874547",
            "telephone_number": "630-937-3030",
            "fax_number": "866-221-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNAMIC PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2019-05-21",
        "status": "A",
        "authorized_official_last_name": "ROUSH",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "419-221-6710",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Body Gears - Wheaton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ivana Dvorakova
• Paul Dwah Jr.
• Renee Dworkin, RN
• Melissa Dybala, N.D., D.C.
• Louise Dykes
• Mateusz Dzikowski, PSY.D.
• Laura A Eagen
• Takisha L Earnest, RN
• Eastern Healing Inc.
• Jessica Eberlin

• Rehabilitation Clinic/Center in Wheaton, IL
• Providers in Wheaton, IL by specialty
• Rehabilitation Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.