Provider Demographics
NPI:1275372336
Name:DUFOUR, PEYTON
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:DUFOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 BELLE CHASSE HWY
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7056
Mailing Address - Country:US
Mailing Address - Phone:504-362-1000
Mailing Address - Fax:
Practice Address - Street 1:102 WOODLAND HWY STE 1
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1674
Practice Address - Country:US
Practice Address - Phone:504-392-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist