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NPI Code Detail

MEDICARE: STEPHANIE KAY DOUGLAS PT

MEDICARE: STEPHANIE KAY DOUGLAS PT
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 Therapist040-0003569VT

General Provider Information

NPI Number : 1225160948
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE KAY DOUGLAS PT
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 : 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
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 07/17/2007

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Directions to “ STEPHANIE KAY DOUGLAS PT” Practice Location

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