Individual provider Active NPI

Justin Dunaway, PT

  • Physical Therapist
  • Mesa, AZ
National Provider Identifier
1003044454
Registry record updated Sep 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8517PT Issued in AZ
Practice address
6632 E Baseline Rd
Suite 102
Mesa, AZ 85206-4426
Phone
(480) 222-0655
Fax
(480) 222-1457
NPI assigned
Jun 24, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 8517PT AZ Primary

Addresses

Primary practice location

6632 E Baseline Rd
Suite 102
Mesa, AZ 85206-4426

Mailing address

PO Box 269084
Oklahoma City, OK 73126-9084
Phone (623) 398-8072

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8517PTAZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ati Holdings of Arizona, LLC Physical Therapist PastSince Mar 1, 2016 Accepting new patients
Stephen a Mitchell Physical Therapist PastSince Feb 1, 2018 Accepting new patients
Ideal Rehabilitation LLC Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314835200000",
    "number": "1003044454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 269084",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731269084",
            "telephone_number": "623-398-8072",
            "fax_number": "623-398-8235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6632 E BASELINE RD",
            "address_2": "SUITE 102",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064426",
            "telephone_number": "480-222-0655",
            "fax_number": "480-222-1457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUNAWAY",
        "first_name": "JUSTIN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-24",
        "last_updated": "2011-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "8517PT",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.