Provider Demographics
NPI:1609038181
Name:DUNNING, RUSSELL EDGAR (PT)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:EDGAR
Last Name:DUNNING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 TIMBERCREEK WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2260
Mailing Address - Country:US
Mailing Address - Phone:916-806-4769
Mailing Address - Fax:
Practice Address - Street 1:9500 MICRON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2617
Practice Address - Country:US
Practice Address - Phone:916-362-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist