Provider Demographics
NPI:1528456530
Name:DUCHESNE, MARTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DUCHESNE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WINTERCORN PL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1138
Mailing Address - Country:US
Mailing Address - Phone:936-447-9260
Mailing Address - Fax:
Practice Address - Street 1:4650 S PANTHER CREEK DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2764
Practice Address - Country:US
Practice Address - Phone:281-363-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-27
Last Update Date:2014-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1184338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist