Healthcare Provider Details

I. General information

NPI: 1174844534
Provider Name (Legal Business Name): GEORGIA DUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MAPLE ST STE 11A
MIDDLEBURY VT
05753-1595
US

IV. Provider business mailing address

76 SEMINARY STREET EXT
MIDDLEBURY VT
05753-1238
US

V. Phone/Fax

Practice location:
  • Phone: 802-377-2507
  • Fax:
Mailing address:
  • Phone: 802-377-2507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: