Provider Demographics
NPI:1699896605
Name:PT DYNAMICS & SPORTS MEDICINE INC
Entity type:Organization
Organization Name:PT DYNAMICS & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:818-348-0580
Mailing Address - Street 1:23101 SHERMAN PL STE 150
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2005
Mailing Address - Country:US
Mailing Address - Phone:818-348-0580
Mailing Address - Fax:818-346-5948
Practice Address - Street 1:22139 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1137
Practice Address - Country:US
Practice Address - Phone:818-348-0580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17365Medicare ID - Type UnspecifiedGROUP NUMBER