Provider Demographics
NPI:1598087595
Name:DAUGEREAUX, PATRICK RODNEY (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RODNEY
Last Name:DAUGEREAUX
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 MEMORIAL HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4573
Mailing Address - Country:US
Mailing Address - Phone:813-884-8877
Mailing Address - Fax:813-886-4980
Practice Address - Street 1:6301 MEMORIAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4573
Practice Address - Country:US
Practice Address - Phone:813-884-8877
Practice Address - Fax:813-886-4980
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57752225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist