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General NPI Number Information
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NPI Number | 1770876195
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Entity Type | Organization
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Legal Business Name | DYNAMIC ORTHOTIC SERVICES, INC.
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 1327 ENTERPRISE BLVD
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City | LAKE CHARLES
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State | LA
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Zip | 70601-6323
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Country | US
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Telephone | 337-291-1016
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Fax | 337-704-0324
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Provider Business Mailing Address
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Address Line | 103 E PINHOOK RD
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City | LAFAYETTE
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State | LA
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Zip | 70501-8531
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Country | US
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Telephone | 337-291-1016
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Fax | 337-704-0324
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SAM MARGAGLIO
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Credential | CO
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Telephone | 337-291-1016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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