Healthcare Provider Details

I. General information

NPI: 1184773392
Provider Name (Legal Business Name): JAMES E DUNKER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 17TH AVENUE
VERO BEACH FL
32960
US

IV. Provider business mailing address

19 PERRIWINKLE CRES
STUART FL
34996-6676
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-6877
  • Fax: 772-562-3153
Mailing address:
  • Phone: 772-219-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: