Healthcare Provider Details

I. General information

NPI: 1538590567
Provider Name (Legal Business Name): VASTA PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 DORSET STREET SUITE 2
SOUTH BURLINGTON VT
05403
US

IV. Provider business mailing address

500 ELFIN HILL LANE
CHARLOTTE VT
05445
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JEFF S ALBERTSON
Title or Position: OWER, PT
Credential: PT
Phone: 802-425-6826