Basic Information
| Provider Information | |||||||||
| NPI: | 1073506598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 232 SUNRISE AVE | ||||||||
| Address2: | |||||||||
| City: | HONESDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184311085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702518003 | ||||||||
| FaxNumber: | 5702518005 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 SUNRISE AVE | ||||||||
| Address2: | |||||||||
| City: | HONESDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184311085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702518003 | ||||||||
| FaxNumber: | 5702518005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | RT009331L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 805660 | 01 | MANAGED PHYSICAL NETWORK | OTHER | DU1369770 | 01 | PA | BLUE SHIELD | OTHER | 253890 | 01 | HEALTH AMERICA | OTHER | 819228 | 01 | 1ST PRIORITY NOLIMITS PT | OTHER | P00172144 | 01 | MEDICARE RR | OTHER | 818279 | 01 | 1ST PRIORITY MOTION PT | OTHER | 9262293 | 01 | PHCS | OTHER |