Provider Demographics
NPI:1780643064
Name:DUFFANY, JOANNE LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:LYNN
Last Name:DUFFANY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:LYNN
Other - Last Name:BASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15872 WOODRING
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-513-7928
Mailing Address - Fax:
Practice Address - Street 1:23550 PARK ST
Practice Address - Street 2:STE 101
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-724-0136
Practice Address - Fax:313-724-0142
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist