Provider Demographics
NPI:1144381914
Name:MENENDEZ, POLLY (PT)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 PITKIN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5120
Mailing Address - Country:US
Mailing Address - Phone:802-859-0788
Mailing Address - Fax:
Practice Address - Street 1:32 PITKIN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5120
Practice Address - Country:US
Practice Address - Phone:802-859-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT29770OtherBLUE CROSS BLUE SHIELD
VT4109991OtherCIGNA HEALTHCARE
VT4696401OtherFLETCHER ALLEN HEALTH CAR
VT364001OtherMVP INSURANCE