MEDICARE: STEPHEN VITALE DPT

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	225100000X	Physical Therapist	22408	MA

General Provider Information

NPI Number	:	1912451667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN VITALE DPT

Provider Business Mailing Address
First Line	:	210 COMMERCE WAY
Second Line	:	SUITE 120
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-8200
Country	:	US
Telephone Number	:	603-427-8066
Fax Number	:	603-501-0495

Provider Business Practice Location Address
First Line	:	3 RUNDLETT WAY
Second Line	:
City	:	MIDDLETON
State	:	MA
Zip	:	01949-2500
Country	:	US
Telephone Number	:	978-624-7150
Fax Number	:	978-624-7149

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

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	08/11/2016

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