Provider Demographics
NPI:1568683779
Name:DUFFY BURNS, DIANE J (RPT)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:J
Last Name:DUFFY BURNS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BURR CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2207
Mailing Address - Country:US
Mailing Address - Phone:203-634-0780
Mailing Address - Fax:203-634-1708
Practice Address - Street 1:292 THORPE AVE
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8309
Practice Address - Country:US
Practice Address - Phone:203-634-0780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist