Provider Demographics
NPI:1750498176
Name:DUQUE, RICARDO I (LPT)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:I
Last Name:DUQUE
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1091
Mailing Address - Country:US
Mailing Address - Phone:740-773-1141
Mailing Address - Fax:740-772-7144
Practice Address - Street 1:65 HANOVER DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1091
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7144
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006354A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist