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General NPI Number Information
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NPI Number | 1689705139
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Entity Type | Organization
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Legal Business Name | GREEN MOUNTAIN REHABILITATION & SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 90 MAIN ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8419
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Country | US
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Telephone | 802-861-6700
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Fax | 802-861-2143
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Provider Business Mailing Address
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Address Line | 90 MAIN ST
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City | BURLINGTON
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State | VT
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Zip | 05401-8419
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Country | US
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Telephone | 802-861-6700
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Fax | 802-861-2143
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Authorized Official
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Title or Position | MEMBER
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Name | ERIC ELSINGER
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Credential | MSPT
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Telephone | 802-861-6700
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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 | 040-0003401
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 040-0003248
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License Number State | VT
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