Provider Demographics
NPI:1083620017
Name:FINNEGAN, MICHAEL PATRICK (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:FINNEGAN
Suffix:
Gender:M
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:PO BOX 91
Mailing Address - Street 2:SLATE VALLEY PHYSICAL THERAPY
Mailing Address - City:BOMOSEEN
Mailing Address - State:VT
Mailing Address - Zip Code:05732-0091
Mailing Address - Country:US
Mailing Address - Phone:802-468-5555
Mailing Address - Fax:802-468-5557
Practice Address - Street 1:218B RT 4A WEST
Practice Address - Street 2:SLATE VALLEY PHYSICAL THERAPY
Practice Address - City:CASTLETON
Practice Address - State:VT
Practice Address - Zip Code:05735
Practice Address - Country:US
Practice Address - Phone:802-468-5555
Practice Address - Fax:802-468-5557
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1040000077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00058299OtherBCBS
VT1008127Medicaid
43220OtherMVP
7592575OtherAETNA
43220OtherMVP