1073551792 NPI number — MRS. ALLISON CONRAD MATUNAS PT

Table of content: MRS. ALLISON CONRAD MATUNAS PT (NPI 1073551792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073551792 NPI number — MRS. ALLISON CONRAD MATUNAS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATUNAS
Provider First Name:
ALLISON
Provider Middle Name:
CONRAD
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEELE
Provider Other First Name:
ALLISON
Provider Other Middle Name:
CONRAD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073551792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 892
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05250-0892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-375-9200
Provider Business Mailing Address Fax Number:
802-375-9288

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 ROUTE 7A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-375-9200
Provider Business Practice Location Address Fax Number:
802-375-9288
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0400003556 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com