Provider Demographics
NPI:1154045029
Name:DUNLAP, COREY (DPT)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 BEEHIVE CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-6850
Mailing Address - Country:US
Mailing Address - Phone:315-883-6321
Mailing Address - Fax:
Practice Address - Street 1:5460 MELTZER CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9430
Practice Address - Country:US
Practice Address - Phone:315-699-1619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist