Healthcare Provider Details

I. General information

NPI: 1457973554
Provider Name (Legal Business Name): DYNAMIC ORTHOTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E PINHOOK RD
LAFAYETTE LA
70501-8531
US

IV. Provider business mailing address

103 E PINHOOK RD
LAFAYETTE LA
70501-8531
US

V. Phone/Fax

Practice location:
  • Phone: 337-291-1016
  • Fax: 337-984-7403
Mailing address:
  • Phone: 337-291-1016
  • Fax: 337-984-7403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: SEBASTIAN MARGAGLIO
Title or Position: PRESIDENT
Credential:
Phone: 337-291-1016