Provider Demographics
NPI:1760638704
Name:DUNLOP, CONSTANCE (PT)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:DUNLOP
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:
Other - Last Name:MANDARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1228 WANTAGH AVENUE
Mailing Address - Street 2:SOUTH SHORE PEDIATRIC PHYSICAL THERAPY, LLP
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:516-785-5257
Mailing Address - Fax:516-785-5154
Practice Address - Street 1:1228 WANTAGH AVENUE
Practice Address - Street 2:SOUTH SHORE PEDIATRIC PHYSICAL THERAPY, LLP
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793
Practice Address - Country:US
Practice Address - Phone:516-785-5257
Practice Address - Fax:516-785-5154
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007719-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics