Provider Demographics
NPI:1114696739
Name:DREAM JAR FARMS LLC
Entity Type:Organization
Organization Name:DREAM JAR FARMS LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTERS WILLISTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:SWINDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:802-857-5407
Mailing Address - Street 1:62 MERCHANTS ROW STE 202
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-4476
Mailing Address - Country:US
Mailing Address - Phone:802-857-5407
Mailing Address - Fax:802-857-5418
Practice Address - Street 1:62 MERCHANTS ROW STE 202
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-4476
Practice Address - Country:US
Practice Address - Phone:802-735-4208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty