Healthcare Provider Details

I. General information

NPI: 1326645102
Provider Name (Legal Business Name): NICHOLAS DUFRESNE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 NEFF AVE STE C
HARRISONBURG VA
22801-3495
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 540-434-1200
  • Fax: 540-434-1203
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-933-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: