MEDICARE: UPPER VALLEY REHABILITATION, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	040-0003101	VT

General Provider Information

NPI Number	:	1205888781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPPER VALLEY REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	PO BOX 28
Second Line	:
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-0028
Country	:	US
Telephone Number	:	802-457-4213
Fax Number	:	802-457-9870

Provider Business Practice Location Address
First Line	:	2588 E WOODSTOCK RD
Second Line	:
City	:	WOODSTOCK
State	:	VT
Zip	:	05091-3661
Country	:	US
Telephone Number	:	802-457-4213
Fax Number	:	802-457-9870

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSHYUA ROYLANCE
Credential	:	PT, MBA
Telephone Number	:	802-457-4213

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	01/24/2025

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