1053966671 NPI number — DEIDRA ROSEMARIE FABBRI DUNN PT, DPT

Table of content: DEIDRA ROSEMARIE FABBRI DUNN PT, DPT (NPI 1053966671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053966671 NPI number — DEIDRA ROSEMARIE FABBRI DUNN PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FABBRI DUNN
Provider First Name:
DEIDRA
Provider Middle Name:
ROSEMARIE
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:
FABBRI
Provider Other First Name:
DEIDRA
Provider Other Middle Name:
ROSEMARIE
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:
1053966671
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 YORK RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-575-1980
Provider Business Mailing Address Fax Number:
630-928-5080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6848 WHITESTOWN PKWY. STE. 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-396-0870
Provider Business Practice Location Address Fax Number:
317-559-6369
Provider Enumeration Date:
08/09/2019

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: 225100000X , with the licence number:  05013467A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com