=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073551792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON CONRAD MATUNAS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2802 ROUTE 7A
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-375-9200
-----------------------------------------------------
Fax | 802-375-9288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 892
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05250-0892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-375-9200
-----------------------------------------------------
Fax | 802-375-9288
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 0400003556
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------