Healthcare Provider Details

I. General information

NPI: 1447241476
Provider Name (Legal Business Name): MICHAEL DAMON KINDOPP P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HARRIS PL
BRATTLEBORO VT
05301-6029
US

IV. Provider business mailing address

56 LINDEN ST
BRATTLEBORO VT
05301-2964
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-4699
  • Fax: 802-257-1985
Mailing address:
  • Phone: 802-254-4699
  • Fax: 802-257-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040-0002796
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: