Provider Demographics
NPI:1598358251
Name:DUTERTE, AUDREY ROSE
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ROSE
Last Name:DUTERTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5318 NORSTAND LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7576
Mailing Address - Country:US
Mailing Address - Phone:281-818-4521
Mailing Address - Fax:
Practice Address - Street 1:5318 NORSTAND LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7576
Practice Address - Country:US
Practice Address - Phone:281-818-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1339629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist