=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811226137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN MATTHEW DUNHAM JR. LMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2009
-----------------------------------------------------
Last Update Date | 12/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2024 W HENRIETTA RD SUITE 5B
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14623-1355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-857-2510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 519 GATES GREECE TOWNLINE RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14606-3452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-857-2510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172M00000X
-----------------------------------------------------
Taxonomy Name | Mechanotherapist
-----------------------------------------------------
License Number | 019742
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------