Mark Lee Dufault Jr., PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

6231 Issued in NC

Practice address

3001 Edwards Mill Rd
# 200
Raleigh, NC 27612-5243

Phone

(919) 863-6872

Fax

(919) 781-5246

NPI assigned

Sep 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Access Physical Therapy, LLC

  • Physical Therapist
  • Clayton, NC
  • NPI 1336612365
  NPD (past)
• RPM Rehab, Inc

  dba Cascade Summit Physical Therapy

  • Massage Therapist
  • Yakima, WA
  • NPI 1316903123

  Physical Therapist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513036800000",
    "number": "1891898268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 EDWARDS MILL RD",
            "address_2": "# 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125243",
            "telephone_number": "919-863-6872",
            "fax_number": "919-781-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 EDWARDS MILL RD",
            "address_2": "# 200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125243",
            "telephone_number": "919-863-6872",
            "fax_number": "919-781-5246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFAULT",
        "first_name": "MARK",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2017-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "6231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1062Y",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Young Duckett, NP
• Jesse Severino Dudas
• Jency Jenee' Dueitt, LCSW
• Nathan Gregory Duell
• Kelly Duewer, PA
• Amy Elizabeth Duffy, PHD LCMHCS NCC CCTP
• Christine Ann Duffy, MSW
• Dorene Marie Duffy
• Katie Marie Duffy
• Connor Dugan, MD

• Physical Therapist in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Physical Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.