Basic Information
| Provider Information | |||||||||
| NPI: | 1962795005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NERY | ||||||||
| FirstName: | DUNN MICHAEL | ||||||||
| MiddleName: | PAPA | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3201 W COMMERCIAL BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333093444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2398502248 | ||||||||
| FaxNumber: | 8664226431 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 SUSAN TART RD | ||||||||
| Address2: | |||||||||
| City: | DUNN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283345557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9108923298 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2011 | ||||||||
| LastUpdateDate: | 05/23/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 13116 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.