Organization
DYNAMIC THERAPY INSTITUTE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNY GOODRICH (CEO)
(786) 317-2526
Entity
Organization
Contact information
Practice address
4471 NW 36TH ST STE 214, MIAMI SPRINGS, FL 33166-7288
(786) 317-2526
Mailing address
4471 NW 36TH ST STE 214, MIAMI SPRINGS, FL 33166-7288
(786) 317-2526
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
MH5842
FL
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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