Healthcare Provider Details

I. General information

NPI: 1538550603
Provider Name (Legal Business Name): MAX K DUMMAR PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 06/18/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 10TH MOUNTAIN DRIVE
FT DRUM NY
13602
US

IV. Provider business mailing address

8103 GRAY WOLF DRIVE
FORT DRUM NY
13603
US

V. Phone/Fax

Practice location:
  • Phone: 315-772-0265
  • Fax:
Mailing address:
  • Phone: 315-772-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1251613
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: