Provider Demographics
NPI:1932350956
Name:DUNNE, EDWARD J (PTA)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:DUNNE
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 1:505 HEARD AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:MAYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12543-1359
Mailing Address - Country:US
Mailing Address - Phone:407-923-0279
Mailing Address - Fax:
Practice Address - Street 1:6551 PARK OF COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-8218
Practice Address - Country:US
Practice Address - Phone:781-322-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18758225200000X
NY66 006069225200000X
VA2306602111225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant