Organization
DYNAMIC EDGE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY A COLE PT (ADMINISTRATOR)
(541) 938-5553
Entity
Organization
Contact information
Practice address
113 S MAIN ST, 113 S. MAIN, MILTON FREEWATER, OR 97862-1342
(541) 938-5553
(541) 938-5554
Mailing address
113 S MAIN ST, 113 S. MAIN, MILTON FREEWATER, OR 97862-1342
(541) 938-5553
(541) 938-5554
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
3061
OR
261QP2000X
Physical Therapy Clinic/Center
PT00006939
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133980
MEDICARE UNSPECIFIED
OR
Enumeration date
02/05/2014
Last updated
02/05/2014
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