MEDICARE: ANNE RODENRYS PT

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1538203765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE RODENRYS PT

Provider Business Mailing Address
First Line	:	PO BOX 45
Second Line	:
City	:	GRAND ISLE
State	:	VT
Zip	:	05458-0045
Country	:	US
Telephone Number	:	802-373-9146
Fax Number	:	802-372-3858

Provider Business Practice Location Address
First Line	:	82 ADAMS SCHOOL RD
Second Line	:
City	:	GRAND ISLE
State	:	VT
Zip	:	05458-2109
Country	:	US
Telephone Number	:	802-373-9146
Fax Number	:	802-372-3858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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