Provider Demographics
NPI:1053802876
Name:DUNN, SALLY MAE (DPT)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:MAE
Last Name:DUNN
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 1:840 DOVETAIL MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9528
Mailing Address - Country:US
Mailing Address - Phone:646-320-5255
Mailing Address - Fax:
Practice Address - Street 1:10211 ALM ST STE 2400
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8222
Practice Address - Country:US
Practice Address - Phone:919-206-4868
Practice Address - Fax:919-206-4860
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558392977Medicaid