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General NPI Number Information
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NPI Number | 1750421772
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Entity Type | Organization
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Legal Business Name | THE REHABGYM INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 373 BLAIR PARK RD UNIT 100
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City | WILLISTON
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State | VT
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Zip | 05495-8077
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Country | US
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Telephone | 802-876-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 373 BLAIR PARK RD UNIT 100
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City | WILLISTON
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State | VT
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Zip | 05495-8077
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Country | US
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Telephone | 802-876-6000
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/BILLING MANAGER
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Name | SEAN LEE JAQUES
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Credential |
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Telephone | 802-565-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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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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