Healthcare Provider Details

I. General information

NPI: 1144025776
Provider Name (Legal Business Name): ELSA CHINBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 COLLEGE PKWY
COLCHESTER VT
05446-3007
US

IV. Provider business mailing address

790 COLLEGE PKWY
COLCHESTER VT
05446-3007
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0134895
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: