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General NPI Number Information
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NPI Number | 1982767968
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Entity Type | Individual
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Provider Name | ALEXIS FAYE PABICH MITTELSTADT P.T.
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 790 COLLEGE PKWY INPATIENT REHABILITATION
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City | COLCHESTER
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State | VT
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Zip | 05446-3007
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Country | US
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Telephone | 802-847-5387
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Fax |
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Provider Business Mailing Address
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Address Line | 204 PEEPER POND LN
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City | CHARLOTTE
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State | VT
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Zip | 05445-9136
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Country | US
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Telephone | 802-985-8122
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 040-0003651
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License Number State | VT
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