Provider Demographics
NPI:1467151738
Name:SHOUP, DURAND (DPT)
Entity Type:Individual
Prefix:DR
First Name:DURAND
Middle Name:
Last Name:SHOUP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1187 KELSO LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9557
Mailing Address - Country:US
Mailing Address - Phone:336-264-9005
Mailing Address - Fax:
Practice Address - Street 1:922 BROAD ST STE D
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4147
Practice Address - Country:US
Practice Address - Phone:336-264-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21943261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy