Individual provider · NPI-1

Ty Austin Duran

Kinesiotherapist · Lake City, FL

NPI number1013613934
StatusActive
Last updated in NPPESFeb 22, 2023

Details

NPI
1013613934
Entity type
Individual (NPI-1)
Name
Ty Austin Duran
Sex
Male
Sole proprietor
No
Enumeration date
Feb 2, 2023
Certification date
Feb 22, 2023
Last updated
Feb 22, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
226300000X Kinesiotherapist––Yes

Practice location

619 S Marion Ave
Lake City, FL 32025-5808

Phone 386-755-3016

Mailing address

493 Sw Dexter Cir Apt 207
Lake City, FL 32025-5673

Phone 662-803-0436

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