1366485666 NPI number — MISS JESSICA RENNIE ALEXANDER PHYSICAL THERAPIST

Table of content: MISS JESSICA RENNIE ALEXANDER PHYSICAL THERAPIST (NPI 1366485666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366485666 NPI number — MISS JESSICA RENNIE ALEXANDER PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXANDER
Provider First Name:
JESSICA
Provider Middle Name:
RENNIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366485666
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:
36 BARBER FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JERICHO
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-899-3726
Provider Business Mailing Address Fax Number:
802-899-5549

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 KENNEDY DR
Provider Second Line Business Practice Location Address:
HOEPPNER PT
Provider Business Practice Location Address City Name:
SOUTH BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-862-4670
Provider Business Practice Location Address Fax Number:
802-862-4670
Provider Enumeration Date:
06/14/2006

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:  0400002533 , 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)

  • Identifier: 200050420 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: OVN2099 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 566686900 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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