1134200207 NPI number — MS. LESLIE H RATHBONE P.T.

Table of content: MS. LESLIE H RATHBONE P.T. (NPI 1134200207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134200207 NPI number — MS. LESLIE H RATHBONE P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RATHBONE
Provider First Name:
LESLIE
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
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:
1134200207
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 1242
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARDWICK
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05843-1242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-472-9800
Provider Business Mailing Address Fax Number:
802-472-9800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 CHURCH ST.
Provider Second Line Business Practice Location Address:
ROOM 5&6
Provider Business Practice Location Address City Name:
HARDWICK
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-472-9800
Provider Business Practice Location Address Fax Number:
802-472-9800
Provider Enumeration Date:
10/17/2006

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:  040-0002140 , 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: 03036 . This is a "CBA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 785248 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0002140 . This is a "FLETCHER ALLEN PREFERRED" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1011429 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29874 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1765159 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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