Provider Demographics
NPI:1598763021
Name:DUQUE, DIANA PATRICIA (MPT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:PATRICIA
Last Name:DUQUE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 PORTSMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4057
Mailing Address - Country:US
Mailing Address - Phone:713-529-4990
Mailing Address - Fax:713-523-2452
Practice Address - Street 1:2158 PORTSMOUTH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4057
Practice Address - Country:US
Practice Address - Phone:713-529-4990
Practice Address - Fax:713-523-2452
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1176540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX690MK599Medicare PIN