Provider Demographics
NPI:1851721245
Name:DUNWOODY, LEEANNE
Entity Type:Individual
Prefix:
First Name:LEEANNE
Middle Name:
Last Name:DUNWOODY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 ANNANDALE RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8558
Mailing Address - Country:US
Mailing Address - Phone:334-216-4357
Mailing Address - Fax:
Practice Address - Street 1:860 ANNANDALE RD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8558
Practice Address - Country:US
Practice Address - Phone:334-216-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist