Provider Demographics
NPI:1699907444
Name:DUNN, NINA RENEE (PT)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:RENEE
Last Name:DUNN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 SOUTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1907
Mailing Address - Country:US
Mailing Address - Phone:707-745-6144
Mailing Address - Fax:707-745-5698
Practice Address - Street 1:127 HOSPITAL DR
Practice Address - Street 2:STE 101
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2500
Practice Address - Country:US
Practice Address - Phone:707-552-8795
Practice Address - Fax:707-552-9638
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 9655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACL529ZMedicare PIN