Provider Demographics
NPI:1982895983
Name:DUMYAHN, DAVID GREGORY (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:DUMYAHN
Suffix:
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:PO BOX 2024
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2024
Mailing Address - Country:US
Mailing Address - Phone:928-639-3068
Mailing Address - Fax:928-639-3346
Practice Address - Street 1:799 COVE PKWY STE B
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4683
Practice Address - Country:US
Practice Address - Phone:928-639-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1698225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ131087Medicaid
AZ131087Medicaid