Provider Demographics
NPI:1073377230
Name:PROACTIVE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:PROACTIVE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-775-4372
Mailing Address - Street 1:279 BUSINESS ROUTE 4 STE 1
Mailing Address - Street 2:
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9701
Mailing Address - Country:US
Mailing Address - Phone:802-775-4372
Mailing Address - Fax:802-775-4918
Practice Address - Street 1:279 BUSINESS ROUTE 4 STE 1
Practice Address - Street 2:
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9701
Practice Address - Country:US
Practice Address - Phone:802-775-4372
Practice Address - Fax:802-775-4918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty