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General NPI Number Information
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NPI Number | 1821684689
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Entity Type | Individual
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Provider Name | JOHN ANTHONY DAUST PT, DPT, MS, ATC
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Gender | Male
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 27317 FIVE CORNERS RD
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City | CALCIUM
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State | NY
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Zip | 13616-2109
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Country | US
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Telephone | 951-310-0182
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Fax |
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Provider Business Mailing Address
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Address Line | 27317 FIVE CORNERS RD
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City | CALCIUM
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State | NY
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Zip | 13616-2109
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Country | US
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Telephone | 951-310-0182
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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