MEDICARE: MINDY LEE COHEN MS 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	3179	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

General Provider Information

NPI Number	:	1881612315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY LEE COHEN MS PT

Provider Business Mailing Address
First Line	:	15 CONIFER CT
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-5915
Country	:	US
Telephone Number	:	802-999-7101
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 PINE HAVEN SHORES RD STE 1000
Second Line	:
City	:	SHELBURNE
State	:	VT
Zip	:	05482-7812
Country	:	US
Telephone Number	:	802-304-4048
Fax Number	:	802-658-1436

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/10/2023

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