Provider Demographics
NPI:1194941955
Name:DUAZO, JOSEPH VENANCIO (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VENANCIO
Last Name:DUAZO
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 1:4004 ULEX AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5346
Mailing Address - Country:US
Mailing Address - Phone:956-874-4274
Mailing Address - Fax:956-467-5901
Practice Address - Street 1:4004 ULEX AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5346
Practice Address - Country:US
Practice Address - Phone:956-874-4274
Practice Address - Fax:956-467-5901
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1067494OtherTX PT LICENSE NUMBER