Provider Demographics
NPI:1306577861
Name:DUNLAP, GWENDOLYN (ACSM EP)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:ACSM EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 N ELM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2878
Mailing Address - Country:US
Mailing Address - Phone:336-713-7620
Mailing Address - Fax:
Practice Address - Street 1:3903 N ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2878
Practice Address - Country:US
Practice Address - Phone:336-713-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
615916224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
615916OtherAMERICAN COLLEGE OF SPORTS MEDICINE