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General NPI Number Information
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NPI Number | 1023456811
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Entity Type | Organization
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Legal Business Name | CORE INTEGRATION VERMONT PLLC
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 20 TECHNOLOGY DR SUITE 8
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City | BRATTLEBORO
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State | VT
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Zip | 05301-9181
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Country | US
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Telephone | 802-257-0810
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 325
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City | MARLBORO
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State | VT
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Zip | 05344-0325
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Country | US
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Telephone | 802-257-0810
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMI HASEGAWA
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Credential | P.T.
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Telephone | 802-257-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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