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NPI Code Detail

MEDICARE: MS. KIMBERLY A BLAISDELL PT, MED

MEDICARE: MS. KIMBERLY A BLAISDELL PT, MED
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
1225100000XPhysical Therapist040-0002341VT

General Provider Information

NPI Number : 1215043187
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY A BLAISDELL PT, MED
Provider Business Mailing Address
First Line : 45 VALLEYVIEW DR
Second Line :
City : ESSEX JCT
State : VT
Zip : 05452-3825
Country : US
Telephone Number : 802-878-7271
Fax Number :
Provider Business Practice Location Address
First Line : 111 COLCHESTER AVE
Second Line : MCHV CAMPUS SHEP 2 PT DEPT
City : BURLINGTON
State : VT
Zip : 05401-1473
Country : US
Telephone Number : 802-847-4731
Fax Number : 802-847-3756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 07/08/2007

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