Individual
MS. DOMINIQUE RENEE DUSHUTTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
2155 W MUSTANG BLVD, BEVERLY HILLS, FL 34465-3520
(352) 746-0019
(352) 746-1035
Mailing address
8477 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(352) 382-7214
(352) 382-7781
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT36739
FL
2251X0800X
Orthopedic Physical Therapist
19956
MD
2251X0800X
Orthopedic Physical Therapist
J1-0001629
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000037946
DELAWARE PHYSICIANS CARE
DE
01
—
386902
MAMSI/UNITED HEALTHCARE
MD
01
—
608308600
US DEPARTMENT OF LABOR
MD
01
—
61106203
CAREFIRST
MD
01
—
754AAT
CAREFIRST GROUP #
MD
01
—
900070997
TAX ID #
MD
01
—
DC4689
RAIL ROAD GROUP #
MD
01
—
J5640001
BLUE CHOICE
MD
01
—
P00200219
RAIL ROAD MEDICARE
MD
Enumeration date
09/26/2006
Last updated
02/19/2021
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