Provider Demographics
NPI:1285831271
Name:DUPLANTIS JR, MALCOLM MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:MALCOLM
Middle Name:MICHAEL
Last Name:DUPLANTIS JR
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 1:9541 MARGAUX DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7664
Mailing Address - Country:US
Mailing Address - Phone:985-630-1656
Mailing Address - Fax:225-756-5063
Practice Address - Street 1:211 E WORTHY ST
Practice Address - Street 2:BLDG IV
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4232
Practice Address - Country:US
Practice Address - Phone:225-644-7044
Practice Address - Fax:225-644-4414
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04755171W00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C811OtherMEDICARD GROUP PTAN
LA721460193OtherTAX ID PT AND HAND CENTER
LA4B693C811OtherMEDICARE GROUP MEMBER PTAN
LA$$$$$$$$$DOtherBCBS PROV NUMBER
LA721460193OtherTAX ID PT AND HAND CENTER