Provider Demographics
NPI:1417272444
Name:DULFAN, FAINA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:FAINA
Middle Name:
Last Name:DULFAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MILTON ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2819
Mailing Address - Country:US
Mailing Address - Phone:508-754-2010
Mailing Address - Fax:508-519-0381
Practice Address - Street 1:65 MILTON ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2819
Practice Address - Country:US
Practice Address - Phone:508-754-2010
Practice Address - Fax:508-519-0381
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18813174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist