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General NPI Number Information
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NPI Number | 1538260302
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Entity Type | Individual
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Provider Name | DOMINIQUE RENEE DUSHUTTLE MSPT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 2155 W MUSTANG BLVD
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-3520
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Country | US
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Telephone | 352-746-0019
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Fax | 352-746-1035
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Provider Business Mailing Address
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Address Line | 8477 S SUNCOAST BLVD
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City | HOMOSASSA
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State | FL
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Zip | 34446-5028
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Country | US
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Telephone | 352-382-7214
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Fax | 352-382-7781
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 19956
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | J1-0001629
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT36739
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License Number State | FL
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