Provider Demographics
NPI:1558374991
Name:DUKE, MICHAEL (PT, CSCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DUKE
Suffix:
Gender:M
Credentials:PT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8017 MANX DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3864
Mailing Address - Country:US
Mailing Address - Phone:512-244-3344
Mailing Address - Fax:
Practice Address - Street 1:12176 N MO PAC EXPY
Practice Address - Street 2:SUITE D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2908
Practice Address - Country:US
Practice Address - Phone:512-977-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1147479OtherLICENSE #