=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851463434
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONALIZED PT, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 LOWER MAIN ST
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05661
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-888-5230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1485
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05661-1485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-888-5230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. KEITH GEISSLER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 802-888-5230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------