Provider Demographics
NPI:1528140043
Name:DUNBAR, BRENT LEE (PT, MS, OCS, FAAOMPT)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:LEE
Last Name:DUNBAR
Suffix:
Gender:M
Credentials:PT, MS, OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 WOODWAY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6170
Mailing Address - Country:US
Mailing Address - Phone:254-776-7864
Mailing Address - Fax:254-776-0775
Practice Address - Street 1:7003 WOODWAY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6170
Practice Address - Country:US
Practice Address - Phone:254-776-7864
Practice Address - Fax:254-776-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1150726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist