Healthcare Provider Details

I. General information

NPI: 1316055924
Provider Name (Legal Business Name): MANSFIELD PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ESSEX WAY SUITE 1116
ESSEX JUNCTION VT
05452-3385
US

IV. Provider business mailing address

21 ESSEX WAY SUITE 116
ESSEX JCT. VT
05452
US

V. Phone/Fax

Practice location:
  • Phone: 802-879-8300
  • Fax: 803-879-9300
Mailing address:
  • Phone: 802-879-8300
  • Fax: 803-879-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. YVONNE LACAILLADE
Title or Position: BUS. OFC. MGR.
Credential:
Phone: 802-879-8300