Provider Demographics
NPI:1356377444
Name:DUNLAP, ROY L JR (PT)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:L
Last Name:DUNLAP
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 MARION ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2939
Mailing Address - Country:US
Mailing Address - Phone:803-253-6721
Mailing Address - Fax:
Practice Address - Street 1:1612 MARION ST
Practice Address - Street 2:SUITE 113
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2939
Practice Address - Country:US
Practice Address - Phone:803-253-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ325086645Medicare PIN