Provider Demographics
NPI:1619091394
Name:DYNATEST INC
Entity Type:Organization
Organization Name:DYNATEST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRUSA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:620-356-3333
Mailing Address - Street 1:118 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2518
Mailing Address - Country:US
Mailing Address - Phone:620-356-3333
Mailing Address - Fax:620-356-3338
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2518
Practice Address - Country:US
Practice Address - Phone:620-356-3333
Practice Address - Fax:620-356-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140589Medicare ID - Type Unspecified
KSS21818Medicare UPIN