Healthcare Provider Details

I. General information

NPI: 1255503819
Provider Name (Legal Business Name): PDM ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CHURCH ST
BURLINGTON VT
05401-4406
US

IV. Provider business mailing address

32 CHURCH ST
BURLINGTON VT
05401-4406
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-2991
  • Fax: 802-658-2992
Mailing address:
  • Phone: 802-658-2991
  • Fax: 802-658-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAM MARTIN
Title or Position: OWNER
Credential:
Phone: 802-658-2991