Healthcare Provider Details

I. General information

NPI: 1780643122
Provider Name (Legal Business Name): DEIRDRE M. FOLSOM PT WCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MALLETTS BAY AVE
WINOOSKI VT
05404-1959
US

IV. Provider business mailing address

32 MALLETTS BAY AVE
WINOOSKI VT
05404-1959
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-0080
  • Fax: 802-847-0310
Mailing address:
  • Phone: 802-847-0080
  • Fax: 802-847-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400002522
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: