Provider Demographics
NPI:1154357861
Name:DYNAMIC REHABILITATION
Entity type:Organization
Organization Name:DYNAMIC REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SZPORKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-649-2323
Mailing Address - Street 1:1500 W BIG BEAVER RD
Mailing Address - Street 2:STE 150
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3522
Mailing Address - Country:US
Mailing Address - Phone:248-649-2323
Mailing Address - Fax:248-649-5998
Practice Address - Street 1:1500 W BIG BEAVER RD
Practice Address - Street 2:STE 150
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3522
Practice Address - Country:US
Practice Address - Phone:248-649-2323
Practice Address - Fax:248-649-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION93670Medicare ID - Type Unspecified
MIN93670Medicare ID - Type Unspecified