Provider Demographics
NPI:1861892143
Name:DUFRESNE, STEVEN (LPTA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:DUFRESNE
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24137 SARAHNELL LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VA
Mailing Address - Zip Code:23487-5563
Mailing Address - Country:US
Mailing Address - Phone:860-857-5044
Mailing Address - Fax:
Practice Address - Street 1:730 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4562
Practice Address - Country:US
Practice Address - Phone:757-873-1557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603847225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant