Basic Information
| Provider Information | |||||||||
| NPI: | 1396120861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DULEY | ||||||||
| FirstName: | CHARITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 454 CAMELOT DR | ||||||||
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| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995082504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733565377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3710 E 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995083418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077444024 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2015 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.