Provider Demographics
NPI:1073947933
Name:DULANEY, TREY (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:TREY
Middle Name:
Last Name:DULANEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25439 N HACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-2453
Mailing Address - Country:US
Mailing Address - Phone:817-909-5539
Mailing Address - Fax:
Practice Address - Street 1:7227 E BASELINE RD STE 129
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-5006
Practice Address - Country:US
Practice Address - Phone:480-219-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1234176225100000X
TX31135522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192079501Medicaid
TX45-6752OtherMEDICARE FACILITY ID