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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