Provider Demographics
NPI:1396907374
Name:DUNN, JACK CHRISTOPHER (DPT)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:CHRISTOPHER
Last Name:DUNN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 BOWDEN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8070
Mailing Address - Country:US
Mailing Address - Phone:960-463-4064
Mailing Address - Fax:904-634-0203
Practice Address - Street 1:10475 CENTURION PKWY N
Practice Address - Street 2:SUITE 220
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5003
Practice Address - Country:US
Practice Address - Phone:960-463-4064
Practice Address - Fax:904-634-0203
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24120225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY904KOtherBCBS OF FLORIDA
FLY904KOtherBCBS OF FLORIDA