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General NPI Number Information
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NPI Number | 1699868091
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Entity Type | Organization
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Legal Business Name | FAMILY PHYSCIAL THERAPY, INC.
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 137 S MAIN ST
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City | WATERBURY
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State | VT
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Zip | 05676-1515
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Country | US
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Telephone | 802-244-1140
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Fax | 802-244-6851
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Provider Business Mailing Address
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Address Line | 137 S MAIN ST
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City | WATERBURY
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State | VT
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Zip | 05676-1515
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Country | US
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Telephone | 802-244-1140
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Fax | 802-244-6851
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAYNE D. COLLINS
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Credential | M.S., P.T., AT,C.
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Telephone | 802-244-1140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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