Healthcare Provider Details

I. General information

NPI: 1922334051
Provider Name (Legal Business Name): ESSENTIAL PHYSICAL THERAPY & PILATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2009
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 RIVER ST STE 201
MONTPELIER VT
05602-3750
US

IV. Provider business mailing address

81 RIVER ST STE 201
MONTPELIER VT
05602-3792
US

V. Phone/Fax

Practice location:
  • Phone: 802-262-1500
  • Fax: 802-262-1505
Mailing address:
  • Phone: 802-262-1500
  • Fax: 802-262-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0400003468
License Number StateVT

VIII. Authorized Official

Name: JAMES T LAMB
Title or Position: PRESIDENT
Credential: MSPT
Phone: 802-262-1500