Provider Demographics
NPI:1316933351
Name:DUNNE, KRISTEN R (PT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:R
Last Name:DUNNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:240 N BLUFF BLVD STE 101
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0337
Mailing Address - Country:US
Mailing Address - Phone:563-519-0242
Mailing Address - Fax:563-241-4353
Practice Address - Street 1:520 7TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1610
Practice Address - Country:US
Practice Address - Phone:563-659-9102
Practice Address - Fax:563-659-9041
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03435225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1283903Medicaid
P18659Medicare UPIN
IA1283903Medicaid