Provider Demographics
NPI:1639786940
Name:DUBOSE, DEWAYNE N (ATC, LAT)
Entity Type:Individual
Prefix:DR
First Name:DEWAYNE
Middle Name:N
Last Name:DUBOSE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 CHESHAM ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-0692
Mailing Address - Country:US
Mailing Address - Phone:813-362-7729
Mailing Address - Fax:
Practice Address - Street 1:344 CHESHAM ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-0692
Practice Address - Country:US
Practice Address - Phone:813-362-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer