Provider Demographics
NPI:1053313155
Name:MOLE, MARGARET B (PT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:B
Last Name:MOLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 BONNET ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9357
Mailing Address - Country:US
Mailing Address - Phone:802-236-8469
Mailing Address - Fax:802-824-4175
Practice Address - Street 1:231 BONNET ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9357
Practice Address - Country:US
Practice Address - Phone:802-236-8469
Practice Address - Fax:802-824-4175
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0000792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2601Medicaid
VN2601Medicare ID - Type Unspecified
VTP36845Medicare UPIN