Provider Demographics
NPI:1215270681
Name:DUCLOS, BRIAN MATTHEW (ATC, PES)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:MATTHEW
Last Name:DUCLOS
Suffix:
Gender:M
Credentials:ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2554
Mailing Address - Country:US
Mailing Address - Phone:540-458-4836
Mailing Address - Fax:540-458-8173
Practice Address - Street 1:204 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2554
Practice Address - Country:US
Practice Address - Phone:540-458-4836
Practice Address - Fax:540-458-8173
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.00876532255A2300X
NH05972255A2300X
VA01260026822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer