Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 005650 | CT |
NPI | 1174902381 |
---|---|
Provider Name | Lynnette Dufresne |
First Address | Hamden, CT 06518-2102 |
Second Address | Hamden, CT 06518-2102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2015 |
Last Update Date | 20/05/2015 |