Healthcare Provider Details

I. General information

NPI: 1912225459
Provider Name (Legal Business Name): DYNAMICS ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W CARSON ST SUITE L
TORRANCE CA
90502-2051
US

IV. Provider business mailing address

1830 W OLYMPIC BLVD. SUITE 123
LOS ANGELES CA
90006-3734
US

V. Phone/Fax

Practice location:
  • Phone: 310-781-1780
  • Fax: 310-781-1067
Mailing address:
  • Phone: 213-383-9212
  • Fax: 213-383-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: PETER J SEAN
Title or Position: CERT. ORTHOTIST PROSTHETIST/CEO
Credential: CPO
Phone: 213-383-9212