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NPI Code Detail

MEDICARE: JOEL DAVID DURAN PT, DPT

MEDICARE:   JOEL DAVID DURAN  PT, DPT
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
1225100000XPhysical Therapist5501015405MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780186387
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL DAVID DURAN PT, DPT
Provider Business Mailing Address
First Line : 4629 E MOCCASIN TRL
Second Line :
City : BERRIEN SPRINGS
State : MI
Zip : 49103-9645
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4368 CLEVELAND AVE
Second Line :
City : STEVENSVILLE
State : MI
Zip : 49127-9595
Country : US
Telephone Number : 269-983-6501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 02/28/2018

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