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General NPI Number Information
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NPI Number | 1619731940
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Entity Type | Individual
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Provider Name | NICHOLAS DUPLISSIS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 945 E SHERMAN BLVD
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City | NORTON SHORES
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State | MI
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Zip | 49444-1805
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Country | US
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Telephone | 231-737-4374
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Fax |
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Provider Business Mailing Address
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Address Line | 829 MOULTON AVE
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City | MUSKEGON
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State | MI
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Zip | 49445-2919
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Country | US
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Telephone | 231-740-4276
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5501303229
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License Number State | MI
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