Provider Demographics
NPI:1780084822
Name:DUNLAP, KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2843 MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1640
Mailing Address - Country:US
Mailing Address - Phone:618-540-8129
Mailing Address - Fax:
Practice Address - Street 1:2843 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1640
Practice Address - Country:US
Practice Address - Phone:618-540-8129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019011241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist