MEDICARE: COLLEEN DUFFY BRUNS 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	040-0003652	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0003652	OTHER	VT	FAHC/VMC PREFERRED APEX
3	385695	OTHER	VT	MVP
4	68947	OTHER	VT	BC/BS

General Provider Information

NPI Number	:	1811966542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN DUFFY BRUNS PT

Provider Business Mailing Address
First Line	:	PO BOX 1451
Second Line	:
City	:	WAITSFIELD
State	:	VT
Zip	:	05673-1451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 HAWTHORNE ST
Second Line	:	MAPLE TREE PLACE
City	:	WILLISTON
State	:	VT
Zip	:	05495-8212
Country	:	US
Telephone Number	:	802-876-6000
Fax Number	:

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	07/08/2007

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