Healthcare Provider Details

I. General information

NPI: 1487814679
Provider Name (Legal Business Name): RICHARD SCOTT TREMBLAY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 HUNTINGTON RD
RICHMOND VT
05477-9708
US

IV. Provider business mailing address

61 HUNTINGTON RD
RICHMOND VT
05477-9708
US

V. Phone/Fax

Practice location:
  • Phone: 802-434-8495
  • Fax:
Mailing address:
  • Phone: 802-434-8495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0077611
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: