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Organization
DYNAMIC THERAPY, LLC
Active
Organization
DYNAMIC THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERALYN KING CALLIHAN-FAVROT PT (PHYSICAL THERAPIST/OWNER)
(225) 749-2065
Entity
Organization
Contact information
Practice address
309 S. VAUGHN DRIVE, SUITE F, BRUSLY, LA 70719
(225) 749-2065
(225) 749-2427
Mailing address
309 S. VAUGHN DRIVE, SUITE F, BRUSLY, LA 70719
(225) 749-2065
(225) 749-2427
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
NULL
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G9567
BLUE CROSS
LA
Enumeration date
05/15/2006
Last updated
07/20/2020
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