Provider Demographics
NPI:1366760530
Name:DUNN PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:DUNN PHYSICAL THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:502-425-1716
Mailing Address - Street 1:PO BOX 22184
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0184
Mailing Address - Country:US
Mailing Address - Phone:502-425-1716
Mailing Address - Fax:502-425-2258
Practice Address - Street 1:4042 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4712
Practice Address - Country:US
Practice Address - Phone:502-899-9363
Practice Address - Fax:502-899-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6155900002Medicare NSC