Healthcare Provider Details

I. General information

NPI: 1114188356
Provider Name (Legal Business Name): VTPT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 MOULTON RD
WAITSFIELD VT
05673-7070
US

IV. Provider business mailing address

PO BOX 486
WILLISTON VT
05495-0486
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-0949
  • Fax:
Mailing address:
  • Phone: 802-658-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CYNTHIA A CRITCHLOW
Title or Position: ADMINISTRATOR
Credential:
Phone: 802-658-0949