Provider Demographics
NPI:1073656971
Name:DUNLOP, RICHARD TRENT (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:TRENT
Last Name:DUNLOP
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54957
Mailing Address - Country:US
Mailing Address - Phone:920-739-1607
Mailing Address - Fax:
Practice Address - Street 1:3112 E PARKSIDE BLVD
Practice Address - Street 2:#28
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-5618
Practice Address - Country:US
Practice Address - Phone:920-739-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7646225100000X
WI19317024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist