Provider Demographics
NPI:1376967018
Name:MIN, DUCKKI (ATC)
Entity Type:Individual
Prefix:
First Name:DUCKKI
Middle Name:
Last Name:MIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PEARY CIR
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630
Mailing Address - Country:US
Mailing Address - Phone:814-886-6328
Mailing Address - Fax:
Practice Address - Street 1:7373 ADMIRAL PEARY HIGHWAY
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1999
Practice Address - Country:US
Practice Address - Phone:814-886-6328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0043902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer