Provider Demographics
NPI:1720298714
Name:DUFFY, MAUREEN (PT, ATP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 ELMFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1713
Mailing Address - Country:US
Mailing Address - Phone:860-521-2234
Mailing Address - Fax:
Practice Address - Street 1:1060 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2407
Practice Address - Country:US
Practice Address - Phone:860-289-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003878225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist