MEDICARE: DORI DUECK LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist		CA

General Provider Information

NPI Number	:	1386885408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORI DUECK LMT

Provider Business Mailing Address
First Line	:	5960 WEST MALL # B
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4232
Country	:	US
Telephone Number	:	805-714-9620
Fax Number	:

Provider Business Practice Location Address
First Line	:	5960 WEST MALL # B
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-4232
Country	:	US
Telephone Number	:	805-714-9620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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