Provider Demographics
NPI:1932111408
Name:DUNCAN, JACQUELINE (PT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:LAMONTAGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25 OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2834
Mailing Address - Country:US
Mailing Address - Phone:860-644-7545
Mailing Address - Fax:860-644-5121
Practice Address - Street 1:25 OAKLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2834
Practice Address - Country:US
Practice Address - Phone:860-644-7545
Practice Address - Fax:860-644-5121
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076572Medicare ID - Type UnspecifiedGROUP ID