Provider Demographics
NPI:1164434981
Name:DUFFETT, THOMAS GARDNER (MS,PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GARDNER
Last Name:DUFFETT
Suffix:
Gender:M
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3789
Mailing Address - Country:US
Mailing Address - Phone:603-437-3563
Mailing Address - Fax:
Practice Address - Street 1:55 HARRIS RD
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2145
Practice Address - Country:US
Practice Address - Phone:603-888-1573
Practice Address - Fax:603-897-0514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2674225100000X
MA15760225100000X
PAPT011311L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2674OtherPHYS THERAPY LICENSE
MA0334065Medicaid
PAPT011311LOtherPHYS THERAPY LICENSE
MA15760OtherPHYS THERAPY LICENSE