MEDICARE: MS. DOMINIQUE RENEE DUSHUTTLE MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	19956	MD
2	2251X0800X	Orthopedic Physical Therapist	J1-0001629	DE
3	225100000X	Physical Therapist	PT36739	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00200219	OTHER	MD	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	386902	OTHER	MD	MAMSI/UNITED HEALTHCARE
2	J5640001	OTHER	MD	BLUE CHOICE
3	61106203	OTHER	MD	CAREFIRST
4	754AAT	OTHER	MD	CAREFIRST GROUP #
5	900070997	OTHER	MD	TAX ID #
6	608308600	OTHER	MD	US DEPARTMENT OF LABOR
7	DC4689	OTHER	MD	RAIL ROAD GROUP #
8	1000037946	OTHER	DE	DELAWARE PHYSICIANS CARE

General Provider Information

NPI Number	:	1538260302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOMINIQUE RENEE DUSHUTTLE MSPT

Provider Business Mailing Address
First Line	:	8477 S SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA
State	:	FL
Zip	:	34446-5028
Country	:	US
Telephone Number	:	352-382-7214
Fax Number	:	352-382-7781

Provider Business Practice Location Address
First Line	:	2155 W MUSTANG BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	FL
Zip	:	34465-3520
Country	:	US
Telephone Number	:	352-746-0019
Fax Number	:	352-746-1035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	02/19/2021

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Directions to “ MS. DOMINIQUE RENEE DUSHUTTLE MSPT” Practice Location

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