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General NPI Number Information
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NPI Number | 1063583441
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Entity Type | Organization
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Legal Business Name | TIMBERLANE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 321 MAIN STREET SUITE D
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City | WINOOSKI
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State | VT
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Zip | 05404
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Country | US
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Telephone | 802-864-3785
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Fax | 802-864-0274
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Provider Business Mailing Address
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Address Line | 321 MAIN STREET SUITE D
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City | WINOOSKI
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State | VT
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Zip | 05404
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Country | US
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Telephone | 802-864-3785
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Fax | 802-864-0274
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | LESLI R BELL
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Credential | PT
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Telephone | 802-864-3785
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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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