Provider Demographics
NPI:1174857361
Name:HEBERT, MARY ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:HEBERT
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 1:208 FLYNN AVE
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5429
Mailing Address - Country:US
Mailing Address - Phone:802-863-9900
Mailing Address - Fax:802-863-9922
Practice Address - Street 1:208 FLYNN AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5429
Practice Address - Country:US
Practice Address - Phone:802-863-9900
Practice Address - Fax:802-863-9922
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0001014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist