Provider Demographics
NPI:1083930200
Name:PROFESSIONAL THERAPY ALTERNATIVES
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPY ALTERNATIVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-747-6394
Mailing Address - Street 1:135 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-3238
Mailing Address - Country:US
Mailing Address - Phone:802-747-6394
Mailing Address - Fax:802-747-9073
Practice Address - Street 1:135 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-3238
Practice Address - Country:US
Practice Address - Phone:802-747-6394
Practice Address - Fax:802-747-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty