Provider Demographics
NPI:1528262987
Name:DUNFORD, BOBBY QUENTIN (LPTA)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:QUENTIN
Last Name:DUNFORD
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 WOLF CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:NARROWS
Mailing Address - State:VA
Mailing Address - Zip Code:24124-2891
Mailing Address - Country:US
Mailing Address - Phone:276-928-0554
Mailing Address - Fax:
Practice Address - Street 1:WESTWOOD CENTER
Practice Address - Street 2:WESTWOOD MEDICAL PARK
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-322-5439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602020225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant