Provider Demographics
NPI:1326634114
Name:DUFFY, MICHAEL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DUFFY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 STONEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4456
Mailing Address - Country:US
Mailing Address - Phone:541-517-6790
Mailing Address - Fax:
Practice Address - Street 1:90 E 27TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3785
Practice Address - Country:US
Practice Address - Phone:541-517-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist