Healthcare Provider Details

I. General information

NPI: 1992774970
Provider Name (Legal Business Name): PAUL ROBERT DUXBURY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BEAM AVE SUITE D
MAPLEWOOD MN
55109-1171
US

IV. Provider business mailing address

PO BOX 86 SDS 12 2901
MINNEAPOLIS MN
55486-2901
US

V. Phone/Fax

Practice location:
  • Phone: 651-767-1756
  • Fax: 651-968-5908
Mailing address:
  • Phone: 651-968-5050
  • Fax: 651-968-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1994
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: