MEDICARE: MR. REGINALD DUNN PT

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	225100000X	Physical Therapist	070011174	IL

General Provider Information

NPI Number	:	1548303662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. REGINALD DUNN PT

Provider Business Mailing Address
First Line	:	2810 FRANK SCOTT PKWY W
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-5007
Country	:	US
Telephone Number	:	618-234-9705
Fax Number	:	618-257-0665

Provider Business Practice Location Address
First Line	:	2810 FRANK SCOTT PKWY W
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-5007
Country	:	US
Telephone Number	:	618-234-9705
Fax Number	:	618-257-0665

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/04/2012

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