Organization
DYNAMIC CARE REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK JEROME VIRAY GONZALES PT (OWNER/MANAGER)
(915) 408-0699
Entity
Organization
Contact information
Practice address
6006 N MESA ST STE 901, EL PASO, TX 79912-4655
(915) 408-0699
(915) 503-2297
Mailing address
6006 N MESA ST STE 901, EL PASO, TX 79912-4655
(915) 408-0699
(915) 503-2297
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
111483
TX
261QP2000X
Physical Therapy Clinic/Center
Primary
1123313
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
669570000
THE EXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS
TX
Enumeration date
03/16/2011
Last updated
03/16/2011
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