Healthcare Provider Details

I. General information

NPI: 1427559707
Provider Name (Legal Business Name): ALLEN JOSEPH DUYCK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870W US HIGHWAY 2
MANISTIQUE MI
49854-8992
US

IV. Provider business mailing address

7870W US HIGHWAY 2
MANISTIQUE MI
49854-8992
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-3299
  • Fax: 906-341-5254
Mailing address:
  • Phone: 906-341-3200
  • Fax: 906-341-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: