Provider Demographics
NPI:1861831968
Name:DUBOIS, JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DUBOIS
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 1:113 LEIGHTON LOOP
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-8320
Mailing Address - Country:US
Mailing Address - Phone:985-868-6185
Mailing Address - Fax:985-876-0180
Practice Address - Street 1:1322 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3961
Practice Address - Country:US
Practice Address - Phone:985-876-9555
Practice Address - Fax:985-876-0180
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA196600Medicare UPIN