MEDICARE: LAURA DUNNICK

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	225100000X	Physical Therapist	PT871617	DC

General Provider Information

NPI Number	:	1467878090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DUNNICK

Provider Business Mailing Address
First Line	:	6307 BEVINGTON PL
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3537
Country	:	US
Telephone Number	:	337-794-9222
Fax Number	:

Provider Business Practice Location Address
First Line	:	10660 PARK RD STE 3200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-8420
Country	:	US
Telephone Number	:	46-672-5007
Fax Number	:

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

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	10/29/2020

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Directions to “ LAURA DUNNICK ” Practice Location

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