Provider Demographics
NPI:1578527859
Name:DUNN, STEPHEN JEROME (ATC, LMT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JEROME
Last Name:DUNN
Suffix:
Gender:M
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W Q ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2188
Mailing Address - Country:US
Mailing Address - Phone:541-988-1434
Mailing Address - Fax:
Practice Address - Street 1:105 W Q ST
Practice Address - Street 2:SUITE #3
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2188
Practice Address - Country:US
Practice Address - Phone:541-988-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
OR5007225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist