Provider Demographics
NPI:1003244534
Name:DUFFY, LAURA V (LMT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:V
Last Name:DUFFY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BELVIDERE AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1451
Mailing Address - Country:US
Mailing Address - Phone:908-500-1316
Mailing Address - Fax:
Practice Address - Street 1:37 BELVIDERE AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1451
Practice Address - Country:US
Practice Address - Phone:908-500-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00488700172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT00488700OtherNJ MASSAGE AND BODYWORK THERAPY