Organization
DYNAMIC PERFORMANCE THERAPY AND REHABILITATION, INC
Active
Organization
DYNAMIC PERFORMANCE THERAPY AND REHABILITATION, INC
Active
Other names
Dynamic Performance Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SAMUEL PETERSON D.P.T. (OWNER/EXECUTIVE DIRECTOR)
(256) 837-5425
Entity
Organization
Contact information
Practice address
147 CASTLE DR, MADISON, AL 35758-8257
(256) 837-5425
(256) 837-2139
Mailing address
147 CASTLE DR, MADISON, AL 35758-8257
(256) 837-5425
(256) 837-2139
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51518990
BLUE CROSS BLUE SHIELD
AL
01
—
J624
MEDICARE PTAN
AL
Enumeration date
11/01/2006
Last updated
07/21/2022
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