=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922711472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMPOWERED PHYSICAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2022
-----------------------------------------------------
Last Update Date | 02/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 WESTERN AVE
-----------------------------------------------------
City | BRATTLEBORO
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05301-3672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-490-1032
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 268 SILVER LN
-----------------------------------------------------
City | VERNON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05354-9419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-380-1736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. KAYLA MATUSZEWSKI
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 802-490-1032
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------