MEDICARE: JAMES DUGAN III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	TEI000679	PA

General Provider Information

NPI Number	:	1457766420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DUGAN III

Provider Business Mailing Address
First Line	:	249 W MCMURRAY RD
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-2468
Country	:	US
Telephone Number	:	724-941-7150
Fax Number	:	724-941-6528

Provider Business Practice Location Address
First Line	:	249 W MCMURRAY RD
Second Line	:
City	:	CANONSBURG
State	:	PA
Zip	:	15317-2468
Country	:	US
Telephone Number	:	724-941-7150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2014
Last Update Date	:	06/27/2014

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