Provider Demographics
NPI:1619161577
Name:DUNLEAVY, DAN PATRICK JR (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:PATRICK
Last Name:DUNLEAVY
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:PATRICK
Other - Last Name:DUNLEAVY
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LAT, ATC
Mailing Address - Street 1:1437 TIPPECANOE ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-2246
Mailing Address - Country:US
Mailing Address - Phone:267-577-1086
Mailing Address - Fax:
Practice Address - Street 1:200 N 7TH ST
Practice Address - Street 2:ATHLETIC TRAINING DEPARTMENT C-06 INDIANA STATE UNIV
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47809-1902
Practice Address - Country:US
Practice Address - Phone:812-237-8232
Practice Address - Fax:812-237-4368
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001426A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer