Organization
DYNAMIC PEAK PHYSICAL THERAPY PT PTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DERILO MIRABUENO DPT (PRESIDENT)
(732) 407-6308
Entity
Organization
Contact information
Practice address
75 ORIENT WAY STE 301, RUTHERFORD, NJ 07070-2086
(201) 351-3055
(201) 351-3184
Mailing address
75 ORIENT WAY STE 301, RUTHERFORD, NJ 07070-2086
(201) 351-3055
(201) 351-3184
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
171100000X
Acupuncturist
—
—
225100000X
Physical Therapist
Primary
40QA01300700
NJ
Other
Enumeration date
03/15/2018
Last updated
07/22/2022
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