Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8517PT | AZ |
NPI | 1003044454 |
---|---|
Provider Name | Justin Dunaway |
First Address | Oklahoma City, OK 73126-9084 |
Second Address | Mesa, AZ 85206-4426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 01/09/2011 |