1699868091 NPI number — FAMILY PHYSCIAL THERAPY, INC.

Table of content: (NPI 1699868091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699868091 NPI number — FAMILY PHYSCIAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHYSCIAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1699868091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05676-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-244-1140
Provider Business Mailing Address Fax Number:
802-244-6851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERBURY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05676-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-244-1140
Provider Business Practice Location Address Fax Number:
802-244-6851
Provider Enumeration Date:
09/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
802-244-1140

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: VT0128 . This is a "MVP PT PROVIDER OFFICE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: CJ3697 . This is a "MEDICARE RR" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 1010606 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4535416 . This is a "CIGNA PT PROVIDER OFFICE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 19023 . This is a "BCBS PT PROVIDER OFFICE" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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