Provider Demographics
NPI:1356080956
Name:DUKE, BRIAN (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:DUKE
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-9695
Mailing Address - Country:US
Mailing Address - Phone:570-452-6352
Mailing Address - Fax:
Practice Address - Street 1:349 CEMETERY ST
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-1028
Practice Address - Country:US
Practice Address - Phone:570-916-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0038312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer