Organization
DYNAMIC PHYSICAL THERAPY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BUSLOV (PARTNER)
(508) 799-6538
Entity
Organization
Contact information
Practice address
111 ELM ST, SUITE 103, WORCESTER, MA 01609-1967
(508) 799-6538
(508) 799-5535
Mailing address
111 ELM ST, SUITE 103, WORCESTER, MA 01609-1967
(508) 799-6538
(508) 799-5535
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
103
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036268
NEIGHBORHOOD HEALTH
MA
01
—
968564
NETWORK HEALTH
MA
05
—
9733451
—
MA
01
—
AA27170
HARVARD PILGRIM
MA
01
—
Y61418
BCBS
MA
Enumeration date
12/29/2006
Last updated
08/22/2020
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