Healthcare Provider Details

I. General information

NPI: 1467500124
Provider Name (Legal Business Name): JOSEPH PHILIP DUROCHER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39830 GRAND RIVER AVE
NOVI MI
48375-2140
US

IV. Provider business mailing address

43208 DEVON LN
CANTON MI
48187-3309
US

V. Phone/Fax

Practice location:
  • Phone: 248-473-5600
  • Fax: 248-473-8480
Mailing address:
  • Phone: 734-844-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: