Provider Demographics
NPI:1083456719
Name:DYNAMIC INSTRUCTION LLC
Entity type:Organization
Organization Name:DYNAMIC INSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:LANETTE
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:941-500-4048
Mailing Address - Street 1:15335 SAM SNEAD LN
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3263
Mailing Address - Country:US
Mailing Address - Phone:567-303-5027
Mailing Address - Fax:
Practice Address - Street 1:15335 SAM SNEAD LN
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33917-3263
Practice Address - Country:US
Practice Address - Phone:567-303-5027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty