Healthcare Provider Details

I. General information

NPI: 1689955890
Provider Name (Legal Business Name): VERMONT PAIN RELIEF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N PROSPECT ST
BURLINGTON VT
05401-3339
US

IV. Provider business mailing address

31 N PROSPECT ST
BURLINGTON VT
05401-3339
US

V. Phone/Fax

Practice location:
  • Phone: 802-752-7990
  • Fax:
Mailing address:
  • Phone: 802-752-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number040-0075983
License Number StateVT

VIII. Authorized Official

Name: DR. KEVIN DUNIHO
Title or Position: CEO
Credential: DPT
Phone: 802-752-7990