MEDICARE: GERALD M. DUFOUR MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT007914L	PA

General Provider Information

NPI Number	:	1437113362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD M. DUFOUR MSPT

Provider Business Mailing Address
First Line	:	2547 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4309
Country	:	US
Telephone Number	:	215-462-3303
Fax Number	:	215-462-3304

Provider Business Practice Location Address
First Line	:	2547 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-4309
Country	:	US
Telephone Number	:	215-462-3303
Fax Number	:	215-462-3304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	05/27/2014

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