Provider Demographics
NPI:1548204258
Name:DUGAN, HERSHEL HAROLD II (PT, MPT)
Entity type:Individual
Prefix:
First Name:HERSHEL
Middle Name:HAROLD
Last Name:DUGAN
Suffix:II
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 VAN AALST BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2102
Mailing Address - Country:US
Mailing Address - Phone:762-408-2336
Mailing Address - Fax:
Practice Address - Street 1:5009 RIVER CHASE DR
Practice Address - Street 2:STE 100C
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7484
Practice Address - Country:US
Practice Address - Phone:334-298-0650
Practice Address - Fax:334-298-1020
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7857225100000X
GAPT007032225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP92360Medicare UPIN