Provider Demographics
NPI:1063671162
Name:DUNLAP, JENNIFER LOUISE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E ELEP AVE
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-5014
Mailing Address - Country:US
Mailing Address - Phone:509-684-2573
Mailing Address - Fax:
Practice Address - Street 1:1000 E ELEP AVE
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-5014
Practice Address - Country:US
Practice Address - Phone:509-684-2573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist