Provider Demographics
NPI:1497849038
Name:DUNBAR, JEFFREY A (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:DUNBAR
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 1:22139 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1137
Mailing Address - Country:US
Mailing Address - Phone:818-348-0580
Mailing Address - Fax:818-348-5948
Practice Address - Street 1:22139 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1137
Practice Address - Country:US
Practice Address - Phone:818-348-0580
Practice Address - Fax:818-346-5948
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21281174400000X
CAPT21281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17365Medicare UPIN