Provider Demographics
NPI:1063571883
Name:DYNAMIC PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:DYNAMIC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WELFEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-434-7044
Mailing Address - Street 1:5775 N UNION BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1744
Mailing Address - Country:US
Mailing Address - Phone:719-434-7044
Mailing Address - Fax:719-375-1276
Practice Address - Street 1:2855 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3144
Practice Address - Country:US
Practice Address - Phone:719-494-1002
Practice Address - Fax:719-494-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68501030Medicaid
CODG0530OtherRAILROAD MEDICARE
CO68501030Medicaid