Provider Demographics
NPI:1255493490
Name:DUNIFER, MARK A (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DUNIFER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1379
Mailing Address - Country:US
Mailing Address - Phone:406-543-2326
Mailing Address - Fax:406-543-2327
Practice Address - Street 1:3620 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1379
Practice Address - Country:US
Practice Address - Phone:406-543-2326
Practice Address - Fax:406-543-2327
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1359PT2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083546Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
MT000050664Medicare ID - Type UnspecifiedPROVIDER NUMBER