Provider Demographics
NPI:1386076230
Name:DULIN, MICHAEL JAMES (PTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:DULIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08029-1417
Mailing Address - Country:US
Mailing Address - Phone:215-932-8718
Mailing Address - Fax:
Practice Address - Street 1:121 4TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:NJ
Practice Address - Zip Code:08029-1417
Practice Address - Country:US
Practice Address - Phone:215-932-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00348600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant