Healthcare Provider Details

I. General information

NPI: 1811479512
Provider Name (Legal Business Name): JACQUELINE K VACHON PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 ETHAN ALLEN HWY
GEORGIA VT
05468
US

IV. Provider business mailing address

PO BOX 2125
MILTON VT
05468-2125
US

V. Phone/Fax

Practice location:
  • Phone: 802-238-7319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: