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Organization
DYNAMIC WELLNESS PHYSICAL THERAPY PC
Active
Organization
DYNAMIC WELLNESS PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARYL LUISA TADABA RASCO DPT (PRESIDENT)
(718) 837-7581
Entity
Organization
Contact information
Practice address
7217 18TH AVE, BROOKLYN, NY 11204-5634
(718) 837-7581
Mailing address
7217 18TH AVE, BROOKLYN, NY 11204-5634
(718) 837-7581
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
031132
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04075590
—
NY
Enumeration date
08/20/2015
Last updated
08/20/2015
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