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General NPI Number Information
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NPI Number | 1942055181
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Entity Type | Individual
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Provider Name | RALEIGH S DUCUT JR. DPT
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Gender | Male
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 110 BURTON ST APT 2
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City | JOHNSTOWN
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State | NY
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Zip | 12095-2023
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Country | US
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Telephone | 203-305-9376
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Fax |
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Provider Business Mailing Address
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Address Line | 110 BURTON ST APT 2
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City | JOHNSTOWN
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State | NY
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Zip | 12095-2023
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Country | US
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Telephone | 203-305-9376
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 041431-01
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License Number State | NY
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