Provider Demographics
NPI:1073030375
Name:DYNAMIC PERFORMANCE AND REHAB
Entity type:Organization
Organization Name:DYNAMIC PERFORMANCE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIONISOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:401-702-0293
Mailing Address - Street 1:1 LAMBERT LIND HWY STE 25
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1072
Mailing Address - Country:US
Mailing Address - Phone:401-702-0293
Mailing Address - Fax:401-655-1744
Practice Address - Street 1:1 LAMBERT LIND HWY STE 25
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1072
Practice Address - Country:US
Practice Address - Phone:401-702-0293
Practice Address - Fax:401-655-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy