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General NPI Number Information
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NPI Number | 1164891883
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Entity Type | Organization
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Legal Business Name | FIT2PERFORM
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Dates
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Enumeration Date | 09/23/2015
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Last Update Date | 09/23/2015
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Provider Practice Location Address
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Address Line | 1191 S BROWNELL RD SUITE 10
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City | WILLISTON
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State | VT
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Zip | 05495-7415
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Country | US
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Telephone | 802-349-4716
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Fax |
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Provider Business Mailing Address
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Address Line | 142 JEANNES WAY
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City | BRISTOL
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State | VT
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Zip | 05443-5447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/CO-OWNER
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Name | SARAH LIVINGSTON
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Credential | PT
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Telephone | 802-349-4716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 040.0098190
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License Number State | VT
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