Provider Demographics
NPI:1750359261
Name:DUNBAR, ABRAM HENDERSON (PT)
Entity type:Individual
Prefix:MR
First Name:ABRAM
Middle Name:HENDERSON
Last Name:DUNBAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17849
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39122-7849
Mailing Address - Country:US
Mailing Address - Phone:601-568-1313
Mailing Address - Fax:601-653-9261
Practice Address - Street 1:105 NORTHGATE RD STE E
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-9162
Practice Address - Country:US
Practice Address - Phone:601-568-1313
Practice Address - Fax:601-653-9261
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125920Medicaid
MSP49443Medicare UPIN