Healthcare Provider Details

I. General information

NPI: 1164434981
Provider Name (Legal Business Name): THOMAS GARDNER DUFFETT MS,PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HARRIS RD
NASHUA NH
03062-2145
US

IV. Provider business mailing address

67 BOULDER DR
LONDONDERRY NH
03053-3789
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-1573
  • Fax: 603-897-0514
Mailing address:
  • Phone: 603-437-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2674
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15760
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT011311L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: