Provider Demographics
NPI:1255855797
Name:DURAN, JUAN PABLO
Entity type:Individual
Prefix:
First Name:JUAN PABLO
Middle Name:
Last Name:DURAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-3201
Mailing Address - Country:US
Mailing Address - Phone:757-271-5055
Mailing Address - Fax:844-442-5168
Practice Address - Street 1:3509 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-3201
Practice Address - Country:US
Practice Address - Phone:757-271-5055
Practice Address - Fax:844-442-5168
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist