Provider Demographics
NPI:1508291477
Name:DUNBAR THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:DUNBAR THERAPY CENTER, LLC
Other - Org Name:DUNBAR THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASPER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANZON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:304-654-6892
Mailing Address - Street 1:1313 DUNBAR AVE
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2920
Mailing Address - Country:US
Mailing Address - Phone:304-400-4896
Mailing Address - Fax:304-400-4897
Practice Address - Street 1:1313 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2920
Practice Address - Country:US
Practice Address - Phone:304-400-4896
Practice Address - Fax:304-400-4897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVOTR/L 1092261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation