Provider Demographics
NPI:1588793210
Name:DUPLESSIS, JOHANNES PETRUS (PT)
Entity type:Individual
Prefix:MR
First Name:JOHANNES
Middle Name:PETRUS
Last Name:DUPLESSIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JON
Other - Middle Name:
Other - Last Name:DUPLESSIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1115 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3970
Mailing Address - Country:US
Mailing Address - Phone:910-256-6999
Mailing Address - Fax:910-256-4777
Practice Address - Street 1:1115 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3970
Practice Address - Country:US
Practice Address - Phone:910-256-6999
Practice Address - Fax:910-256-4777
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16536OtherBCBS NC
NCE2215OtherMEDCOST
NC11458735OtherCAQH
713168OtherUNITED HEALTHCARE
NC079NROtherBCBS
NC2672919OtherCIGNA
NC7999659OtherAETNA
713168OtherUNITED HEALTHCARE