Healthcare Provider Details

I. General information

NPI: 1982909917
Provider Name (Legal Business Name): CPL PREMIER THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2011
Last Update Date: 01/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FAIRFAX RD
SAINT ALBANS VT
05478-6299
US

IV. Provider business mailing address

19 TUTTLE PL
MIDDLETOWN CT
06457-1881
US

V. Phone/Fax

Practice location:
  • Phone: 802-752-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number041-0000504
License Number StateVT

VIII. Authorized Official

Name: TODD PATTERSON
Title or Position: OTR
Credential:
Phone: 802-658-4200