MEDICARE: MRS. NICOLE WHITNEY DAVIGNON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	040.0086066	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144585530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE WHITNEY DAVIGNON DPT

Provider Business Mailing Address
First Line	:	23 SAN REMO DR
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6343
Country	:	US
Telephone Number	:	802-865-0010
Fax Number	:	802-865-0050

Provider Business Practice Location Address
First Line	:	166 ATHLETIC DR
Second Line	:
City	:	SHELBURNE
State	:	VT
Zip	:	05482-4433
Country	:	US
Telephone Number	:	802-985-4440
Fax Number	:	802-985-4445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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