Provider Demographics
NPI:1154693265
Name:DUENAS, MICHAEL ANGELO CARILLO (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL ANGELO
Middle Name:CARILLO
Last Name:DUENAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 ROSSON ST
Mailing Address - Street 2:
Mailing Address - City:NOLANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76559-4788
Mailing Address - Country:US
Mailing Address - Phone:954-778-7305
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:FORT CAVAZOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-04
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1214160225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist