Provider Demographics
NPI:1427605526
Name:DUFAULT, MAGGIE (DPT)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:DUFAULT
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 1:600 COLE FARM RD UNIT B32
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-1368
Mailing Address - Country:US
Mailing Address - Phone:401-523-9631
Mailing Address - Fax:
Practice Address - Street 1:600 COLE FARM RD UNIT B32
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-1368
Practice Address - Country:US
Practice Address - Phone:401-523-9631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5184225100000X
MD27723225100000X
MA24957225100000X
LA10656R225100000X
VA2305213001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist