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MALCOLM MICHAEL DUPLANTIS JR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
211 E WORTHY ST, BLDG IV, GONZALES, LA 70737-4232
(225) 644-7044
(225) 644-4414
Mailing address
9541 MARGAUX DR, BATON ROUGE, LA 70817-7664
(985) 630-1656
(225) 756-5063

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
04755
LA
225100000X
Physical Therapist
Primary
04755
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4B693C811
MEDICARE GROUP MEMBER PTAN
LA
01
5C811
MEDICARD GROUP PTAN
LA
01
721460193
TAX ID PT AND HAND CENTER
LA
Enumeration date
07/02/2007
Last updated
08/08/2012
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