MEDICARE: MR. MARC DOUEK

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	225100000X	Physical Therapist	10117	NC

General Provider Information

NPI Number	:	1396922274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARC DOUEK

Provider Business Mailing Address
First Line	:	1714 CANTERBURY RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27608-1110
Country	:	US
Telephone Number	:	919-791-6260
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 HARGROVE RD STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27616-1949
Country	:	US
Telephone Number	:	919-791-6260
Fax Number	:

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

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	09/17/2020

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