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General NPI Number Information
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NPI Number | 1285831271
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Entity Type | Individual
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Provider Name | MALCOLM MICHAEL DUPLANTIS JR PT
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Gender | Male
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 211 E WORTHY ST BLDG IV
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City | GONZALES
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State | LA
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Zip | 70737-4232
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Country | US
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Telephone | 225-644-7044
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Fax | 225-644-4414
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Provider Business Mailing Address
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Address Line | 9541 MARGAUX DR
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City | BATON ROUGE
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State | LA
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Zip | 70817-7664
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Country | US
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Telephone | 985-630-1656
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Fax | 225-756-5063
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 04755
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 04755
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License Number State | LA
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