Healthcare Provider Details

I. General information

NPI: 1356645741
Provider Name (Legal Business Name): NORDIC REHAB @ WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 NORTH MAIN ST
CAMBRIDGE VT
05444
US

IV. Provider business mailing address

PO BOX 152
CAMBRIDGE VT
05444-0152
US

V. Phone/Fax

Practice location:
  • Phone: 802-644-5803
  • Fax: 802-644-2810
Mailing address:
  • Phone: 802-644-5803
  • Fax: 802-644-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateVT

VIII. Authorized Official

Name: MR. CHARLES S HAYES
Title or Position: OWNER
Credential:
Phone: 802-644-5803