Provider Demographics
NPI:1598174245
Name:DUMM, JUSTIN LEWIS (PTA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:LEWIS
Last Name:DUMM
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 BOLD VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7130
Mailing Address - Country:US
Mailing Address - Phone:614-906-9950
Mailing Address - Fax:
Practice Address - Street 1:2767 BOLD VENTURE DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7130
Practice Address - Country:US
Practice Address - Phone:614-906-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3625225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant