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NPI Code Detail

MEDICARE: JOEL A DESAUTELS MPT ATC

MEDICARE: JOEL A DESAUTELS MPT ATC
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
1225100000XPhysical Therapist040-0003725VT

General Provider Information

NPI Number : 1457344590
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOEL A DESAUTELS MPT ATC
Provider Business Mailing Address
First Line : 449 NICHOLS RD
Second Line :
City : FAIRFAX
State : VT
Zip : 05454-9614
Country : US
Telephone Number : 802-849-0202
Fax Number :
Provider Business Practice Location Address
First Line : 426 INDUSTRIAL AVE
Second Line : SUITE 190
City : WILLISTON
State : VT
Zip : 05495-4448
Country : US
Telephone Number : 802-860-4360
Fax Number : 802-488-3160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 09/21/2012

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Directions to “ JOEL A DESAUTELS MPT ATC” Practice Location

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