Provider Demographics
NPI:1114046935
Name:LEDUC, JAIME ANN (PT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ANN
Last Name:LEDUC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LEDUC
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-6996
Mailing Address - Fax:
Practice Address - Street 1:3 TIMBER LN
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7205
Practice Address - Country:US
Practice Address - Phone:802-847-2391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59223OtherBLUE CROSS BLUE SHIELD
VT5265603OtherVMC
VT4124859OtherMVP