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General NPI Number Information
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NPI Number | 1619161577
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Entity Type | Individual
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Provider Name | DAN PATRICK DUNLEAVY JR. LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 09/04/2007
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Provider Practice Location Address
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Address Line | 200 N 7TH ST ATHLETIC TRAINING DEPARTMENT C-06 INDIANA STATE UNIV
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City | TERRE HAUTE
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State | IN
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Zip | 47809-1902
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Country | US
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Telephone | 812-237-8232
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Fax | 812-237-4368
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Provider Business Mailing Address
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Address Line | 1437 TIPPECANOE ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-2246
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Country | US
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Telephone | 267-577-1086
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36001426A
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License Number State | IN
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