Provider Demographics
NPI:1952585135
Name:MAURY, DOUGLAS E (ATC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:MAURY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 5TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1126
Mailing Address - Country:US
Mailing Address - Phone:316-258-7336
Mailing Address - Fax:
Practice Address - Street 1:208 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-9022
Practice Address - Country:US
Practice Address - Phone:712-707-7348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-0003512255A2300X
IA0972602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer