Facts
- Status
- A
- Credential
- PT, DPT
- Type
- Individual
- Enumeration date
- 2012-10-15
- Last updated
- 2012-10-15
Licenses
- License NY
- 033588-1
- License VT
- 040.0090673
Location
- Practice location
- 1282 MAIN ST
- City
- FAIRFAX VT
- Postal code
- 054549534
- Phone
- 802-849-9308
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.