Healthcare Provider Details

I. General information

NPI: 1396445268
Provider Name (Legal Business Name): HOMETOWN PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S MAIN ST
ROCHESTER VT
05767-9679
US

IV. Provider business mailing address

222 S MAIN ST
ROCHESTER VT
05767-9679
US

V. Phone/Fax

Practice location:
  • Phone: 802-767-4295
  • Fax:
Mailing address:
  • Phone: 802-345-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICKAELA JILL RICHARDSON
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT/PT
Phone: 802-767-7117