Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT34454 | CA |
N | 2251E1200X | Ergonomics | PT34454 | CA |
N | 225XE1200X | Ergonomics | PT34454 | CA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT34454 | CA |
N | 2251H1200X | Hand | PT34454 | CA |
N | 2251N0400X | Physical Therapist - Neurology | PT34454 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT34454 | CA |
N | 2251S0007X | Physical Therapist - Sports | PT34454 | CA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT34454 | CA |
NPI | 1235317066 |
---|---|
Provider Name | Jared Michael Dunn |
First Address | Clovis, CA 93611-0223 |
Second Address | Clovis, CA 93611-0223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 09/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT34454 | PT LICENSE (01) | CA |