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General NPI Number Information
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NPI Number | 1609069194
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Entity Type | Organization
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Legal Business Name | DF STATELINE THERAPYWORKS, LLC
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 5087 RTE 5 STE 1 BUILDING B
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City | ASCUTNEY
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State | VT
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Zip | 05030
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Country | US
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Telephone | 603-869-4802
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | ASCUTNEY
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State | VT
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Zip | 05030-0487
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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 | OWNER
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Name | DEBORAH FIELDING
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Credential | MSPT
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Telephone | 603-835-6649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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