Provider Demographics
NPI:1013991991
Name:DUMAS, DOUGLAS HERBERT (MPT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:HERBERT
Last Name:DUMAS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIS, NAVAL AIR FACILITY
Mailing Address - Street 2:BLDG 94 UNIT 5048
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96319
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:EDIS, NAVAL AIR FACILITY
Practice Address - Street 2:BLDG 94 UNIT 5048
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96319
Practice Address - Country:JP
Practice Address - Phone:226-9039
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1098606OtherPHYSICAL THERAPY LICENSE