Provider Demographics
NPI:1124070081
Name:DUPONT, LAUREL (PT)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:
Last Name:DUPONT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 IRA E WOODS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-4023
Mailing Address - Country:US
Mailing Address - Phone:817-481-8585
Mailing Address - Fax:817-488-8282
Practice Address - Street 1:1217 IRA E WOODS AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4023
Practice Address - Country:US
Practice Address - Phone:817-481-8585
Practice Address - Fax:817-488-8282
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist