Provider Demographics
NPI:1083658280
Name:DUNAVANT, JASON EVERETTT (ATC,LAT,RMT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:EVERETTT
Last Name:DUNAVANT
Suffix:
Gender:M
Credentials:ATC,LAT,RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TEAKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-6602
Mailing Address - Country:US
Mailing Address - Phone:325-674-2230
Mailing Address - Fax:325-674-6831
Practice Address - Street 1:5 TEAKWOOD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-6602
Practice Address - Country:US
Practice Address - Phone:325-674-2230
Practice Address - Fax:325-674-6831
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT24292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer