1124566369 NPI number — AMANDA DUNN PT, DPT

Table of content: AMANDA DUNN PT, DPT (NPI 1124566369)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124566369 NPI number — AMANDA DUNN PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNN
Provider First Name:
AMANDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AKRIDGE
Provider Other First Name:
AMANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124566369
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
259 N BROAD ST UNIT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREVARD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28712-4505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-883-3141
Provider Business Mailing Address Fax Number:
828-348-8091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
259 N BROAD ST UNIT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREVARD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28712-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-883-3141
Provider Business Practice Location Address Fax Number:
828-348-8091
Provider Enumeration Date:
02/08/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  P16923 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: P16923 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)