Provider Demographics
NPI:1306833892
Name:DUKE, DAVID TREY (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:TREY
Last Name:DUKE
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 1:1815 ROSELAWN AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5433
Mailing Address - Country:US
Mailing Address - Phone:318-322-7050
Mailing Address - Fax:318-322-7031
Practice Address - Street 1:1907 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4069
Practice Address - Country:US
Practice Address - Phone:318-283-8384
Practice Address - Fax:318-283-8355
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04497F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H005Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER