Provider Demographics
NPI:1508176371
Name:LE DUFF, ANTHONY PHILLIP (CMT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:PHILLIP
Last Name:LE DUFF
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25341 MADISON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9000
Mailing Address - Country:US
Mailing Address - Phone:951-970-3848
Mailing Address - Fax:
Practice Address - Street 1:25341 MADISON AVE STE 101
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9000
Practice Address - Country:US
Practice Address - Phone:951-970-3848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5654225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist