Provider Demographics
NPI:1821151218
Name:DUPORT, PAUL JR (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DUPORT
Suffix:JR
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 1:9154 ESTATE THOMAS
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2687
Mailing Address - Country:US
Mailing Address - Phone:965-371-6528
Mailing Address - Fax:
Practice Address - Street 1:9152 SUGAR ESTATE PARK
Practice Address - Street 2:
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-776-7667
Practice Address - Fax:340-714-1891
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist