1659407013 NPI number — RONNA MARIE DAVINE PT

Table of content: KARINA TOIRAC (NPI 1053972513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659407013 NPI number — RONNA MARIE DAVINE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVINE
Provider First Name:
RONNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
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:
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:
1659407013
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:
5 ALBERT CREE DR
Provider Second Line Business Mailing Address:
VERMONT SPORTS MEDICINE CENTER
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-775-1300
Provider Business Mailing Address Fax Number:
802-773-9300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 ALBERT CREE DR
Provider Second Line Business Practice Location Address:
VERMONT SPORTS MEDICINE CENTER
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-775-1300
Provider Business Practice Location Address Fax Number:
802-773-9300
Provider Enumeration Date:
02/27/2007

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:  0400002469 , 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: 988038 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00004675 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: OVN2144 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".