Provider Demographics
NPI:1407573116
Name:ORTHODYNAMX LLC
Entity type:Organization
Organization Name:ORTHODYNAMX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-961-1449
Mailing Address - Street 1:2735 W STATE ROAD 434 UNIT 1021
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4483
Mailing Address - Country:US
Mailing Address - Phone:407-637-5957
Mailing Address - Fax:
Practice Address - Street 1:2735 W STATE ROAD 434 UNIT 1021
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4483
Practice Address - Country:US
Practice Address - Phone:407-637-5957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies