Provider Demographics
NPI:1447639570
Name:DUNN, ELIZABETH (MSPT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TRADECENTER
Mailing Address - Street 2:SUITE 4890
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-7452
Mailing Address - Country:US
Mailing Address - Phone:781-937-9777
Mailing Address - Fax:
Practice Address - Street 1:400 TRADECENTER
Practice Address - Street 2:SUITE 4890
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7452
Practice Address - Country:US
Practice Address - Phone:781-937-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15129225100000X
NH2522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2522OtherSTATE OF NEW HAMPSHIRE OFFICE OF LICENSED ALLIED HEALTH PROFESSIONALS
MA15129OtherCOMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE