Healthcare Provider Details

I. General information

NPI: 1760494629
Provider Name (Legal Business Name): CHRISTINA HR ALLARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 DEWEY RD
FAIRFAX VT
05454-9612
US

IV. Provider business mailing address

34 DEWEY RD
FAIRFAX VT
05454-9612
US

V. Phone/Fax

Practice location:
  • Phone: 802-527-9958
  • Fax:
Mailing address:
  • Phone: 802-527-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number040-0003264
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: