Provider Demographics
NPI:1972077931
Name:DUFORT, VINCENT MICHEL (PHD, LMT)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:MICHEL
Last Name:DUFORT
Suffix:
Gender:M
Credentials:PHD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO FALLS
Mailing Address - State:NH
Mailing Address - Zip Code:03896-1132
Mailing Address - Country:US
Mailing Address - Phone:207-251-2218
Mailing Address - Fax:
Practice Address - Street 1:35 CENTER ST STE 8
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4324
Practice Address - Country:US
Practice Address - Phone:833-569-1347
Practice Address - Fax:833-569-1347
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2023-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7110MT225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist