Organization
DYNAMIC THERAPY, LLC
Active
Parent organization
DYNAMIC THERAPY, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DYNAMIC THERAPY, LLC
Authorized official
SHERALYN K CALLIHAN-FAVROT PT (PT/OWNER)
(225) 749-2065
Entity
Organization
Contact information
Practice address
309 S VAUGHN DRIVE, SUITE F, BRUSLY, LA 70719
(225) 749-2065
(225) 749-2427
Mailing address
309 S VAUGHN DRIVE, SUITE F, BRUSLY, LA 70719
(225) 749-2065
(225) 749-2427
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
01005
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
437370614B
BLUE CROSS BLUE SHIELD
LA
01
—
G9567
BLUE CROSS
LA
Enumeration date
08/06/2008
Last updated
07/20/2020
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