MEDICARE: MR. CORY JAMES HEALY 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
1	208100000X	Physical Medicine & Rehabilitation Physician	0400002586	VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08Y002458VT01	OTHER	NH	ANTHEM BCNH
2	43909	OTHER	VT	MOHAWK VALLEY PLAN
3	212102	OTHER		CIGNA

General Provider Information

NPI Number	:	1306920715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CORY JAMES HEALY PT

Provider Business Mailing Address
First Line	:	43 SCHOOL ST
Second Line	:
City	:	NORTH SPRINGFIELD
State	:	VT
Zip	:	05150-9751
Country	:	US
Telephone Number	:	802-886-2321
Fax Number	:	802-886-2567

Provider Business Practice Location Address
First Line	:	43 SCHOOL ST
Second Line	:
City	:	NORTH SPRINGFIELD
State	:	VT
Zip	:	05150-9751
Country	:	US
Telephone Number	:	802-886-2321
Fax Number	:	802-886-2567

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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