Provider Demographics
NPI:1275042178
Name:DUNN, MIKAELA OLIVIA (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:MIKAELA
Middle Name:OLIVIA
Last Name:DUNN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 ASHBY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2220
Mailing Address - Country:US
Mailing Address - Phone:802-793-9529
Mailing Address - Fax:
Practice Address - Street 1:1888 ASHBY AVE APT 2
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2220
Practice Address - Country:US
Practice Address - Phone:802-793-9529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0129073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist