Healthcare Provider Details

I. General information

NPI: 1063198851
Provider Name (Legal Business Name): DUNBAR PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 DUNBAR AVENUE
DUNBAR WV
25064
US

IV. Provider business mailing address

PO BOX 398
SALT ROCK WV
25559
US

V. Phone/Fax

Practice location:
  • Phone: 304-400-4896
  • Fax: 304-400-4897
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASPER BANZON
Title or Position: OWNER
Credential:
Phone: 304-400-4896