Provider Demographics
NPI:1891786711
Name:DYNAMIC ORTHOTIC SERVICES, INC.
Entity Type:Organization
Organization Name:DYNAMIC ORTHOTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGAGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:337-291-1016
Mailing Address - Street 1:103 E PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-8531
Mailing Address - Country:US
Mailing Address - Phone:337-291-1016
Mailing Address - Fax:337-704-0324
Practice Address - Street 1:103 E PINHOOK RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8531
Practice Address - Country:US
Practice Address - Phone:337-291-1016
Practice Address - Fax:337-704-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QP2000X
LA0790402001335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187143Medicaid
LA1266440001Medicare NSC
LA1266440004Medicare NSC
LA1266440002Medicare NSC
LA1266440003Medicare NSC