MEDICARE: POWERBACK PEDIATRICS OF VERMONT, LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1609622067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POWERBACK PEDIATRICS OF VERMONT, LLC

Provider Business Mailing Address
First Line	:	101 E STATE ST
Second Line	:
City	:	KENNETT SQUARE
State	:	PA
Zip	:	19348-3109
Country	:	US
Telephone Number	:	888-269-9876
Fax Number	:

Provider Business Practice Location Address
First Line	:	861 WILLISTON RD STE 8
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-5724
Country	:	US
Telephone Number	:	888-269-9876
Fax Number	:

Authorized Official
Title or Position	:	EVP OF PEDIATRICS
Name	:	JOHN COTCHER
Credential	:
Telephone Number	:	248-672-2593

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

Similar Medicare Providers

1841962438 — DR. CHRISTOPHER JOHN SERNAQUE EDD, RP
Practice Location Address:

861 WILLISTON RD STE 8
SOUTH BURLINGTON, VT
05403-5724

Practice Phone: 813-591-0761
Practice Fax:

1952382301 — DR. MICHAEL SD AGUS MD
Practice Location Address:

300 LONGWOOD AVE , MAIN 11 SOUTH
BOSTON, MA
02115-5724

Practice Phone: 617-355-5849
Practice Fax: 888-883-9238

1295897429 — DR. RACHEL AMY TUNICK PH.D.
Practice Location Address:

300 LONGWOOD AVE , CHILDREN'S HOSPITAL BOSTON, MAIN 8-SOUTH
BOSTON, MA
02115-5724

Practice Phone: 617-355-9830
Practice Fax:

1174741383 — MS. DENISE N CURRIER CPNP
Practice Location Address:

300 LONGWOOD AVE , 9 SOUTH
BOSTON, MA
02115-5724

Practice Phone: 617-355-8700
Practice Fax:

1053588061 — MRS. SUSAN DECKERS GIULIETTI MS, FNP-C
Practice Location Address:

300 LONGWOOD AVE , 11 SOUTH, MICU
BOSTON, MA
02115-5724

Practice Phone: 617-355-8117
Practice Fax:

1033386727 — KERI J SULLIVAN RN, MS, CPNP
Practice Location Address:

300 LONGWOOD AVE , 9 SOUTH
BOSTON, MA
02115-5724

Practice Phone: 617-355-0943
Practice Fax: 617-730-0795

Directions to “POWERBACK PEDIATRICS OF VERMONT, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.