Healthcare Provider Details

I. General information

NPI: 1700710225
Provider Name (Legal Business Name): CHARLES DAVID DUNAVAN DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29822 S WIXOM RD
WIXOM MI
48393-3434
US

IV. Provider business mailing address

9368 N LILLEY RD
PLYMOUTH MI
48170-4610
US

V. Phone/Fax

Practice location:
  • Phone: 248-926-5826
  • Fax: 248-926-5830
Mailing address:
  • Phone: 248-926-5826
  • Fax: 248-926-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304574
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: