Organization
DYNAMIC KIDS THERAPY AZ LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JAMES CLIPNER (CEO)
(614) 270-4607
Entity
Organization
Contact information
Practice address
3026 W FERRUCCIO PL, PHOENIX, AZ 85086-3217
(614) 270-4607
Mailing address
3026 W FERRUCCIO PL, PHOENIX, AZ 85086-3217
(614) 270-4607
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
699173
—
AZ
Enumeration date
12/19/2019
Last updated
12/19/2019
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