MEDICARE: MR. JUSTIN LEWIS DUMM PTA

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	3625	OH

General Provider Information

NPI Number	:	1598174245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUSTIN LEWIS DUMM PTA

Provider Business Mailing Address
First Line	:	2767 BOLD VENTURE DR
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-7130
Country	:	US
Telephone Number	:	614-906-9950
Fax Number	:

Provider Business Practice Location Address
First Line	:	2767 BOLD VENTURE DR
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-7130
Country	:	US
Telephone Number	:	614-906-9950
Fax Number	:

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

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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