Healthcare Provider Details

I. General information

NPI: 1881612315
Provider Name (Legal Business Name): MINDY LEE COHEN MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PINE HAVEN SHORES RD STE 1000
SHELBURNE VT
05482-7812
US

IV. Provider business mailing address

15 CONIFER CT
BURLINGTON VT
05401-5915
US

V. Phone/Fax

Practice location:
  • Phone: 802-304-4048
  • Fax: 802-658-1436
Mailing address:
  • Phone: 802-999-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3179
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: