Basic Information
| Provider Information | |||||||||
| NPI: | 1417080821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUKE | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | GREGORY | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10969 SE 175TH PLACE ROAD | ||||||||
| Address2: | |||||||||
| City: | SUMMERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523478877 | ||||||||
| FaxNumber: | 3523479477 | ||||||||
| Practice Location | |||||||||
| Address1: | 10969 SE 175TH PLACE ROAD | ||||||||
| Address2: | |||||||||
| City: | SUMMERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523478877 | ||||||||
| FaxNumber: | 3523479477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA16613 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.