Provider Demographics
NPI:1912225459
Name:DYNAMICS ORTHOTICS & PROSTHETICS, INC.
Entity type:Organization
Organization Name:DYNAMICS ORTHOTICS & PROSTHETICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERT. ORTHOTIST PROSTHETIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SEAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:213-383-9212
Mailing Address - Street 1:1830 W OLYMPIC BLVD.
Mailing Address - Street 2:SUITE 123
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3734
Mailing Address - Country:US
Mailing Address - Phone:213-383-9212
Mailing Address - Fax:213-383-6421
Practice Address - Street 1:1001 W CARSON ST
Practice Address - Street 2:SUITE L
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2051
Practice Address - Country:US
Practice Address - Phone:310-781-1780
Practice Address - Fax:310-781-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912225459Medicaid
CA0227030003Medicare NSC