Provider Demographics
NPI:1316078462
Name:DUFFEY, MICHAEL BRYANT SR (MED,LATC,CSA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRYANT
Last Name:DUFFEY
Suffix:SR
Gender:M
Credentials:MED,LATC,CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HUNTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-1212
Mailing Address - Country:US
Mailing Address - Phone:610-358-2268
Mailing Address - Fax:
Practice Address - Street 1:2004 SPROUL RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3511
Practice Address - Country:US
Practice Address - Phone:610-359-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000108A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer