Provider Demographics
NPI:1053790097
Name:DUNN, HOLLY AVERY
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:AVERY
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 FIVE STAR BLVD.
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-4135
Mailing Address - Country:US
Mailing Address - Phone:916-624-3500
Mailing Address - Fax:916-624-3351
Practice Address - Street 1:6805 FIVE STAR BLVD.
Practice Address - Street 2:SUITE #100
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-4135
Practice Address - Country:US
Practice Address - Phone:916-624-3500
Practice Address - Fax:916-624-3500
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist