Organization
DYNAMIC THERAPY CONCEPTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY LISA HALL PT, DPT (DOCTOR OF PHYSICAL THERAPY)
(270) 705-5898
Entity
Organization
Contact information
Practice address
245 JENNIFER LYNN DR, PADUCAH, KY 42001-4861
(270) 705-5898
Mailing address
245 JENNIFER LYNN DR, PADUCAH, KY 42001-4861
(270) 705-5898
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002256
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000551156
ANTHEM BC & BS
KY
01
—
00454
MEDICARE GROUP
KY
01
—
1033121868
INDIVIDUAL NPI
KY
01
—
11856022
CAQH
—
05
—
7100057690
—
KY
01
—
DG4266
MEDICARE RR - GROUP
KY
01
—
P00435045
MEDICARE RR - PTAN
KY
Enumeration date
08/22/2007
Last updated
04/26/2018
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