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General NPI Number Information
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NPI Number | 1972077931
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Entity Type | Individual
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Provider Name | VINCENT MICHEL DUFORT PHD, LMT
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Gender | Male
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Dates
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Enumeration Date | 01/13/2019
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Last Update Date | 09/24/2023
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Provider Practice Location Address
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Address Line | 35 CENTER ST STE 8
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City | WOLFEBORO
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State | NH
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Zip | 03894-4324
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Country | US
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Telephone | 833-569-1347
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Fax | 833-569-1347
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Provider Business Mailing Address
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Address Line | PO BOX 1132
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City | WOLFEBORO FALLS
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State | NH
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Zip | 03896-1132
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Country | US
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Telephone | 207-251-2218
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 7110MT
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License Number State | NH
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