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General NPI Number Information
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NPI Number | 1174745038
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Entity Type | Individual
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Provider Name | JOHN R. DE BITETTO MSPT
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 3800 MAIN STREET
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City | MANCHESTER
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State | VT
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Zip | 05254
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Country | US
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Telephone | 802-768-8369
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2493
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City | MANCHESTER CENTER
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State | VT
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Zip | 05255-2493
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 040.0102092
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License Number State | VT
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