Healthcare Provider Details

I. General information

NPI: 1972661197
Provider Name (Legal Business Name): ALPINE PHYSICAL THERAPY & SPORTS CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 MAIN STREET
MANCHESTER VT
05254
US

IV. Provider business mailing address

P.O. BOX 2493
MANCHESTER CENTER VT
05255
US

V. Phone/Fax

Practice location:
  • Phone: 802-768-8369
  • Fax: 914-769-8077
Mailing address:
  • Phone:
  • Fax:

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: JOHN DEBITETTO
Title or Position: PRESIDENT
Credential: M.S.P.T.
Phone: 914-806-3788