Healthcare Provider Details

I. General information

NPI: 1164509980
Provider Name (Legal Business Name): NORTHERN PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 MAIN ST
LYNDONVILLE VT
05851
US

IV. Provider business mailing address

PO BOX 1346
LYNDONVILLE VT
05851-1346
US

V. Phone/Fax

Practice location:
  • Phone: 802-626-4224
  • Fax: 802-626-5042
Mailing address:
  • Phone: 802-626-4224
  • Fax: 802-626-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANDA PALMER
Title or Position: VP OF ADMIN
Credential:
Phone: 802-626-4224