Provider Demographics
NPI:1912542770
Name:DUNN, MCKINLEY CRUISE (ATC)
Entity Type:Individual
Prefix:
First Name:MCKINLEY
Middle Name:CRUISE
Last Name:DUNN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 COTTAGE ROSE LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5489
Mailing Address - Country:US
Mailing Address - Phone:850-443-2609
Mailing Address - Fax:
Practice Address - Street 1:403 STADIUM DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-4247
Practice Address - Country:US
Practice Address - Phone:850-443-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL53312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer