Provider Demographics
NPI:1073717112
Name:FREEDOM PHYSICAL THERAPY, P.C
Entity Type:Organization
Organization Name:FREEDOM PHYSICAL THERAPY, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNE
Authorized Official - Middle Name:BRETON
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:802-334-2400
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:VT
Mailing Address - Zip Code:05829-0626
Mailing Address - Country:US
Mailing Address - Phone:802-334-2400
Mailing Address - Fax:802-334-2550
Practice Address - Street 1:419A VT RT 105
Practice Address - Street 2:SUITE B
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855
Practice Address - Country:US
Practice Address - Phone:802-766-4799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty