Provider Demographics
NPI:1083641351
Name:DUQUETTE, THOMAS LOUIS (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LOUIS
Last Name:DUQUETTE
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 1:5206 SAVANNAH CRK
Mailing Address - Street 2:
Mailing Address - City:VON ORMY
Mailing Address - State:TX
Mailing Address - Zip Code:78073-3001
Mailing Address - Country:US
Mailing Address - Phone:210-624-3209
Mailing Address - Fax:
Practice Address - Street 1:2200 BERGQUIST DR STE 1
Practice Address - Street 2:ATTN: CREDENTIALS (CMC)
Practice Address - City:LACKLAND A F B
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-6707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist