Provider Demographics
NPI:1811226137
Name:DUNHAM, JOHN MATTHEW JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MATTHEW
Last Name:DUNHAM
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 GATES GREECE TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-3452
Mailing Address - Country:US
Mailing Address - Phone:585-857-2510
Mailing Address - Fax:
Practice Address - Street 1:2024 W HENRIETTA RD
Practice Address - Street 2:SUITE 5B
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1355
Practice Address - Country:US
Practice Address - Phone:585-857-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019742172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist