MEDICARE: MR. RUSSELL EDGAR DUNNING P.T.

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	PT34637	CA

General Provider Information

NPI Number	:	1609038181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUSSELL EDGAR DUNNING P.T.

Provider Business Mailing Address
First Line	:	4941 TIMBERCREEK WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-2260
Country	:	US
Telephone Number	:	916-806-4769
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MICRON AVE
Second Line	:	SUITE 104
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2617
Country	:	US
Telephone Number	:	916-362-7962
Fax Number	:

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	06/26/2008

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