Provider Demographics
NPI:1538550603
Name:DUMMAR, MAX K (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:K
Last Name:DUMMAR
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8103 GRAY WOLF DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT DRUM
Mailing Address - State:NY
Mailing Address - Zip Code:13603
Mailing Address - Country:US
Mailing Address - Phone:315-772-0265
Mailing Address - Fax:
Practice Address - Street 1:10000 10TH MOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:FT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602
Practice Address - Country:US
Practice Address - Phone:315-772-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1251613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist