Provider Demographics
NPI:1265490858
Name:FORNEY, DUSTIN RONALD (AT/PTA)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:RONALD
Last Name:FORNEY
Suffix:
Gender:M
Credentials:AT/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8737 UNION CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4878
Mailing Address - Country:US
Mailing Address - Phone:513-645-2246
Mailing Address - Fax:513-545-2233
Practice Address - Street 1:8737 UNION CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4878
Practice Address - Country:US
Practice Address - Phone:513-645-2246
Practice Address - Fax:513-545-2233
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT26602255A2300X
OHPTA.06556225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant