Healthcare Provider Details

I. General information

NPI: 1215954904
Provider Name (Legal Business Name): MINDY COHEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 KILLBURN STREET
BURLINGTON VT
05401
US

IV. Provider business mailing address

11 KILLBURN STREET
BURLINGTON VT
05401
US

V. Phone/Fax

Practice location:
  • Phone: 802-865-9500
  • Fax: 802-865-9559
Mailing address:
  • Phone: 802-865-9500
  • Fax: 802-865-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3179
License Number StateVT

VIII. Authorized Official

Name: MINDY LEE COHEN
Title or Position: PRESIDENT PHYSICAL THERAPIST
Credential: MSPT
Phone: 802-865-9500