Provider Demographics
NPI:1124239363
Name:DYNAMIC KIDS, INC.
Entity type:Organization
Organization Name:DYNAMIC KIDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:TIJERINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-433-4700
Mailing Address - Street 1:755 N PEACH AVE STE G14
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7247
Mailing Address - Country:US
Mailing Address - Phone:559-433-4700
Mailing Address - Fax:559-234-1440
Practice Address - Street 1:755 N PEACH AVE STE G14
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-7247
Practice Address - Country:US
Practice Address - Phone:559-433-4700
Practice Address - Fax:559-234-1440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25969261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy