Healthcare Provider Details

I. General information

NPI: 1376408815
Provider Name (Legal Business Name): CHARLANA DUNN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 SIKES AVE
SIKESTON MO
63801-5021
US

IV. Provider business mailing address

2299 STATE HWY E
SCOTT CITY MO
63780-9193
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-5755
  • Fax:
Mailing address:
  • Phone: 573-225-7896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number20150020022
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: