Provider Demographics
NPI:1801122908
Name:DUFRENE, MELISSA DUFOUR (PT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DUFOUR
Last Name:DUFRENE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 PRIVATEER BLVD
Mailing Address - Street 2:
Mailing Address - City:BARATARIA
Mailing Address - State:LA
Mailing Address - Zip Code:70036-5715
Mailing Address - Country:US
Mailing Address - Phone:504-689-2274
Mailing Address - Fax:
Practice Address - Street 1:2365 PRIVATEER BLVD
Practice Address - Street 2:
Practice Address - City:BARATARIA
Practice Address - State:LA
Practice Address - Zip Code:70036-5715
Practice Address - Country:US
Practice Address - Phone:504-689-2274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist