Provider Demographics
NPI:1518991710
Name:DULLMEYER, EDWARD JOHN (PT, MBA, OCS, CSCS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:DULLMEYER
Suffix:
Gender:M
Credentials:PT, MBA, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LAKE HOWELL ROAD
Mailing Address - Street 2:SUITE 1031
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5906
Mailing Address - Country:US
Mailing Address - Phone:407-671-0433
Mailing Address - Fax:407-671-2433
Practice Address - Street 1:405 LAKE HOWELL ROAD
Practice Address - Street 2:SUITE 1031
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5906
Practice Address - Country:US
Practice Address - Phone:407-671-0433
Practice Address - Fax:407-671-2433
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY1068AMedicare ID - Type Unspecified