DYNAMIC EDGE PHYSICAL THERAPY LLC (NPI# 1013331479) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013331479 |
| Entity Type | Organization |
| Organization Name | DYNAMIC EDGE PHYSICAL THERAPY LLC |
| Practice Address |
113 S Main St 113 S. Main Milton Freewater OR 97862-1342 |
| Practice Telephone | 5419385553 |
| Practice Fax Number | 5419385554 |
| Mailing Telephone | 5419385553 |
| Mailing Fax Number | 5419385554 |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-05 |
| Authorized Official Name | MRS. KIMBERLY A COLE (ADMINISTRATOR) |
| Authorized Official Telephone | 5419385553 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
PT00006939 | WA | Ambulatory Health Care Facilities |
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
3061 | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | MEDICARE UNSPECIFIED | 133980 | 01 |
| Street Address |
113 S MAIN ST 113 S. MAIN |
| City | MILTON FREEWATER |
| State | OR |
| Zip Code | 97862-1342 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538627062 | Atlantic Home Health Care, LLC | Home Health | 113 S Main St, Milton Freewater, OR 97862-1342 | 2019-03-04 |
| 1790295228 | Clarke Podiatry, LLC | Podiatrist | 113 S Main St, Milton Freewater, OR 97862-1342 | 2017-10-11 |
| 1134570948 | Julie Medrano | Counselor | 113 S Main St, Milton Freewater, OR 97862-1342 | 2016-06-23 |
| 1710075619 | Manford E. Anliker | Physical Therapist | 113 S Main St, Milton Freewater, OR 97862-1342 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528538352 | Paksupim Cole | Massage Therapist | 85452 Hwy 11, Milton Freewater, OR 97862 | 2018-12-05 |
| 1356812192 | Lacey Elizabeth Rose Klem | Massage Therapist | 85458 Hywy 11, Milton Freewater, OR 97862 | 2018-12-05 |
| 1770778664 | Amon Chiropractic LLC | Chiropractor | 85458 Hwy 11, Milton Freewater, OR 97862 | 2007-09-13 |
| 1215001052 | Broadway Family Dental Care LLC | Dentist | 508 E Broadway, Milton Freewater, OR 97862 | 2006-11-20 |
| 1750462917 | Sarah S Hsu | Social Worker | 1253 Stonewood Ct, Milton Freewater, OR 97862 | 2006-10-17 |
| 1548890916 | Divine Mansiba Maganto | Nurse's Aide | 1010 Ne 3rd Ave, Milton Freewater, OR 97862 | 2020-01-24 |
| 1902317621 | Michael David Bruno | Speech-Language Pathologist | 120 Elzora St, Milton Freewater, OR 97862 | 2017-10-20 |
| 1821475286 | Danielle Strickland | Massage Therapist | 533 S Main St, Milton Freewater, OR 97862-1017 | 2015-05-05 |
| 1457476392 | Alicia A Taylor | Registered Nurse | 110 Sw 4th Ave, Milton Freewater, OR 97862-1031 | 2007-03-20 |
| 1225401151 | Serenity Counseling PC | Community/Behavioral Health | 1253 Stonewood Ct, Milton Freewater, OR 97862-1067 | 2015-10-30 |
| Find all providers in zip 97862 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356715460 | Total Motion Physical Therapy | Clinic/Center | 85081 Tum A Lum Rd, Milton Freewater, OR 97862-7411 | 2015-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292639 | Blueprint Sports Therapy | Clinic/Center | 17440 Sw Reusser Ct, Beaverton, OR 97007-8772 | 2020-10-14 |
| 1790383982 | Fluid Movement LLC | Clinic/Center | 2565 Bowmont Dr, Eugene, OR 97405-1407 | 2020-10-11 |
| 1184221335 | Convergence Physical Therapy and Performance | Clinic/Center | 303 S 5th St Ste 140, Springfield, OR 97477-5480 | 2020-10-01 |
| 1356969976 | Readygo Physical Therapy LLC | Clinic/Center | 904 Se 69th Ave, Portland, OR 97215-2120 | 2020-07-09 |
| 1619591815 | Cyti LLC | Clinic/Center | 11350 Sw Canyon Rd # 202, Beaverton, OR 97005-2234 | 2020-06-03 |
| 1144865841 | St. Johns Physical Therapy | Clinic/Center | 8835 N Bradford St, Portland, OR 97203-2869 | 2019-11-18 |
| 1750930004 | Revolutions Physical Therapy LLC | Clinic/Center | 8751 Sw Pamlico Ct, Tualatin, OR 97062-9345 | 2019-09-10 |
| 1487202362 | Mpt LLC | Clinic/Center | 98158 W Benham Ln Ste 10, Brookings, OR 97415-9546 | 2019-09-03 |
| 1215584446 | Patrick Franko Pt LLC | Clinic/Center | 2331 Ne 43rd Ave, Portland, OR 97213-1332 | 2019-08-22 |
| 1689228686 | Ground Work Physical Therapy | Clinic/Center | 2330 Ne Division St Ste 1, Bend, OR 97703-3570 | 2019-07-29 |
| Find all providers with the same taxonomy | ||||
| City | MILTON FREEWATER |
| Zip Code | 97862 |
Please comment or provide details below to improve the information on DYNAMIC EDGE PHYSICAL THERAPY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.