Provider Demographics
NPI:1073947933
Name:DULANEY, TREY (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:TREY
Middle Name:
Last Name:DULANEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10512 SILVER FOX CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-8320
Mailing Address - Country:US
Mailing Address - Phone:817-909-5539
Mailing Address - Fax:
Practice Address - Street 1:6037 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4103
Practice Address - Country:US
Practice Address - Phone:817-370-9891
Practice Address - Fax:817-370-9894
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31135522251X0800X
TX1234176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-6752OtherMEDICARE FACILITY ID
TX192079501Medicaid