Provider Demographics
NPI:1891713806
Name:DULLMEYER, ERIC JAMES (MPT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:DULLMEYER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SAUSALITO BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5720
Mailing Address - Country:US
Mailing Address - Phone:407-671-0433
Mailing Address - Fax:407-671-2433
Practice Address - Street 1:260 SAUSALITO BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5720
Practice Address - Country:US
Practice Address - Phone:407-671-0433
Practice Address - Fax:407-671-2433
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 21784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4414ZMedicare ID - Type Unspecified