MEDICARE: CROWN POINT PHYSICAL THERAPY ASSOCIATES PC

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	208100000X	Physical Medicine & Rehabilitation Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VN2076	OTHER	VT	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5813	OTHER	VT	BCBS

General Provider Information

NPI Number	:	1225251952
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN POINT PHYSICAL THERAPY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	43 SCHOOL STREET
Second Line	:
City	:	NORTH SPRINGFIELD
State	:	VT
Zip	:	05150
Country	:	US
Telephone Number	:	802-886-2321
Fax Number	:	802-886-2567

Provider Business Practice Location Address
First Line	:	43 SCHOOL STREET
Second Line	:
City	:	NORTH SPRINGFIELD
State	:	VT
Zip	:	05150
Country	:	US
Telephone Number	:	802-886-2321
Fax Number	:	802-886-2567

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CARLA J KELLEY
Credential	:	PT
Telephone Number	:	802-886-2321

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	03/09/2015

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