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General NPI Number Information
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NPI Number | 1548441090
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Entity Type | Organization
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Legal Business Name | VILLAGE STREET PHYSICAL THERAPY AND SPORTS MEDICINE P.C.
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 12 VILLAGE ST SUITE 10
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3828
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Country | US
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Telephone | 203-562-8140
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Fax |
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Provider Business Mailing Address
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Address Line | 12 VILLAGE ST SUITE 10
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3828
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Country | US
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Telephone | 203-562-8140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MICHAEL DUFRESNE
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Credential |
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Telephone | 203-562-8140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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