Provider Demographics
NPI:1841998101
Name:DUNBAUGH, BRIAN CARL (PTA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CARL
Last Name:DUNBAUGH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ROSERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6058
Mailing Address - Country:US
Mailing Address - Phone:864-325-2435
Mailing Address - Fax:
Practice Address - Street 1:319 MILLS AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4021
Practice Address - Country:US
Practice Address - Phone:864-233-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4560225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant