=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518265743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA DUNDAS P.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2011
-----------------------------------------------------
Last Update Date | 03/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 ROSEMONT BLVD
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91775-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-289-3304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 ROSEMONT BLVD
-----------------------------------------------------
City | SAN GABRIEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91775-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-289-3304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT 17054
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------