Healthcare Provider Details

I. General information

NPI: 1164891883
Provider Name (Legal Business Name): FIT2PERFORM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 S BROWNELL RD SUITE 10
WILLISTON VT
05495-7415
US

IV. Provider business mailing address

142 JEANNES WAY
BRISTOL VT
05443-5447
US

V. Phone/Fax

Practice location:
  • Phone: 802-349-4716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number040.0098190
License Number StateVT

VIII. Authorized Official

Name: SARAH LIVINGSTON
Title or Position: PHYSICAL THERAPIST/CO-OWNER
Credential: PT
Phone: 802-349-4716