Provider Demographics
NPI:1750603106
Name:DYNAMIC PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Entity type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY & SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-859-3991
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-1497
Mailing Address - Country:US
Mailing Address - Phone:417-859-3991
Mailing Address - Fax:417-859-0100
Practice Address - Street 1:1350 SPUR DR STE 180
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2190
Practice Address - Country:US
Practice Address - Phone:417-859-3991
Practice Address - Fax:417-859-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy