Provider Demographics
NPI:1508892027
Name:DUNCOMBE, JOHN VINYARD (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VINYARD
Last Name:DUNCOMBE
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 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:1757 NORTHWIND BLVD
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048
Practice Address - Country:US
Practice Address - Phone:224-206-0200
Practice Address - Fax:224-206-0201
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9778-24225100000X
MI5501012458225100000X
IL070-013278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00898821OtherMEDICARE RAILROAD
ILR03786Medicare PIN
ILP00898821OtherMEDICARE RAILROAD
IL216859055Medicare PIN
ILK09026Medicare PIN
IL211585028Medicare PIN
ILR02090Medicare PIN
MIP09920008Medicare ID - Type Unspecified
ILR03787Medicare PIN