MEDICARE: VILLAGE STREET PHYSICAL THERAPY AND SPORTS MEDICINE P.C.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OV1735	OTHER	CT	HEALTHNET
2	7614976004	OTHER	CT	CIGNA
3	183259	OTHER	CT	WELLCARE
4	080002017CT01	OTHER	CT	BCBS
5	897715	OTHER	CT	AETNA
6	A531345	OTHER	CT	OXFORD

General Provider Information

NPI Number	:	1548441090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE STREET PHYSICAL THERAPY AND SPORTS MEDICINE P.C.

Provider Business Mailing Address
First Line	:	12 VILLAGE ST
Second Line	:	SUITE 10
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3828
Country	:	US
Telephone Number	:	203-562-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 VILLAGE ST
Second Line	:	SUITE 10
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3828
Country	:	US
Telephone Number	:	203-562-8140
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN MICHAEL DUFRESNE
Credential	:
Telephone Number	:	203-562-8140

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	10/13/2011

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Directions to “VILLAGE STREET PHYSICAL THERAPY AND SPORTS MEDICINE P.C. ” Practice Location

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