Provider Demographics
NPI:1477331510
Name:LOUIS, DUCKENS
Entity Type:Individual
Prefix:
First Name:DUCKENS
Middle Name:
Last Name:LOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 SEVEN SPRINGS BLVD APT 37D
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-1613
Mailing Address - Country:US
Mailing Address - Phone:561-704-4303
Mailing Address - Fax:
Practice Address - Street 1:5700 LAKE WORTH RD STE 201-H
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3204
Practice Address - Country:US
Practice Address - Phone:561-704-4303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist