Provider Demographics
NPI:1821061888
Name:DUCREST, PAUL JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:DUCREST
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52396
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2396
Mailing Address - Country:US
Mailing Address - Phone:337-232-3111
Mailing Address - Fax:337-232-5400
Practice Address - Street 1:816 HARDING ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2320
Practice Address - Country:US
Practice Address - Phone:337-232-3111
Practice Address - Fax:337-232-5400
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T025CB92Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER