1073506598 NPI number — KEVIN PATRICK DUNN P.T.

Table of content: KEVIN PATRICK DUNN P.T. (NPI 1073506598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073506598 NPI number — KEVIN PATRICK DUNN P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNN
Provider First Name:
KEVIN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1073506598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 SUNRISE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONESDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18431-1085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-251-8003
Provider Business Mailing Address Fax Number:
570-251-8005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 SUNRISE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONESDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18431-1085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-251-8003
Provider Business Practice Location Address Fax Number:
570-251-8005
Provider Enumeration Date:
08/30/2005

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:  RT009331L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 805660 . This is a "MANAGED PHYSICAL NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: DU1369770 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 253890 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 819228 . This is a "1ST PRIORITY NOLIMITS PT" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00172144 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 818279 . This is a "1ST PRIORITY MOTION PT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9262293 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".




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