Provider Demographics
NPI:1861168437
Name:DUSSEAULT, DEVON (DPT)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:DUSSEAULT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TURKEY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026-9564
Mailing Address - Country:US
Mailing Address - Phone:860-245-8914
Mailing Address - Fax:860-957-2364
Practice Address - Street 1:3 TURKEY HILLS RD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026-9564
Practice Address - Country:US
Practice Address - Phone:860-245-8914
Practice Address - Fax:860-957-2364
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty