Provider Demographics
NPI:1083732374
Name:DUFFY, DONNA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-2127
Mailing Address - Country:US
Mailing Address - Phone:860-928-7061
Mailing Address - Fax:
Practice Address - Street 1:72 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1810
Practice Address - Country:US
Practice Address - Phone:860-928-0891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist