| NPI | 1750421772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN LEE JAQUES Authorized Official/Billing Manager 802-565-1422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2018-05-10 |