Provider Demographics
NPI:1073506598
Name:DUNN, KEVIN PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:DUNN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:232 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1085
Mailing Address - Country:US
Mailing Address - Phone:570-251-8003
Mailing Address - Fax:570-251-8005
Practice Address - Street 1:232 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1085
Practice Address - Country:US
Practice Address - Phone:570-251-8003
Practice Address - Fax:570-251-8005
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART009331L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
805660OtherMANAGED PHYSICAL NETWORK
PADU1369770OtherBLUE SHIELD
253890OtherHEALTH AMERICA
819228Other1ST PRIORITY NOLIMITS PT
P00172144OtherMEDICARE RR
818279Other1ST PRIORITY MOTION PT
9262293OtherPHCS
253890OtherHEALTH AMERICA