Basic Information
| Provider Information | |||||||||
| NPI: | 1902866353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNHAM | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC, LAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 N PARK BLVD | ||||||||
| Address2: | APT 2406 | ||||||||
| City: | GRAPEVINE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760517833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172512085 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 580 S DENTON TAP RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723049100 | ||||||||
| FaxNumber: | 9723049048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT2254 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.