Healthcare Provider Details

I. General information

NPI: 1245616366
Provider Name (Legal Business Name): REGAN DEWHIRST DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 DORSET ST SUITE 2
SOUTH BURLINGTON VT
05403-6306
US

IV. Provider business mailing address

340 DORSET ST SUITE 2
SOUTH BURLINGTON VT
05403-6306
US

V. Phone/Fax

Practice location:
  • Phone: 802-399-2244
  • Fax:
Mailing address:
  • Phone: 802-399-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040.0111632
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number040.0111632
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: