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Organization
DYNAMIC REHABILITATION
Active
Organization
DYNAMIC REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH RONALDO ELUMBA MPT (PRESIDENT)
(949) 300-3423
Entity
Organization
Contact information
Practice address
28 STYLE DR, ALISO VIEJO, CA 92656-8090
(949) 300-1105
(949) 215-1961
Mailing address
28 STYLE DR, ALISO VIEJO, CA 92656-8090
(949) 300-1105
(949) 215-1961
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT22423
CA
225100000X
Physical Therapist
—
—
2251E1200X
Ergonomics Physical Therapist
PT22423
CA
2251N0400X
Neurology Physical Therapist
PT22423
CA
2251X0800X
Orthopedic Physical Therapist
PT22423
CA
225XN1300X
Neurorehabilitation Occupational Therapist
OT2859
CA
225XP0019X
Physical Rehabilitation Occupational Therapist
OT2859
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ69019Z
BLUE SHIELD GROUP ID
CA
Enumeration date
09/13/2006
Last updated
11/23/2022
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