Basic Information
| Provider Information | |||||||||
| NPI: | 1669619268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DYNAMIX PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1004 | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383581004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316132214 | ||||||||
| FaxNumber: | 7316132215 | ||||||||
| Practice Location | |||||||||
| Address1: | 2060 RHINO XING | ||||||||
| Address2: | |||||||||
| City: | MILAN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383585201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316132214 | ||||||||
| FaxNumber: | 7316132215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2009 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | HUFFSTETLER | ||||||||
| AuthorizedOfficialFirstName: | RUSS | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7316132214 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.