Provider Demographics
NPI:1225251952
Name:CROWN POINT PHYSICAL THERAPY ASSOCIATES PC
Entity Type:Organization
Organization Name:CROWN POINT PHYSICAL THERAPY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-886-2321
Mailing Address - Street 1:43 SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05150
Mailing Address - Country:US
Mailing Address - Phone:802-886-2321
Mailing Address - Fax:802-886-2567
Practice Address - Street 1:43 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:NORTH SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05150
Practice Address - Country:US
Practice Address - Phone:802-886-2321
Practice Address - Fax:802-886-2567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN2076OtherMEDICARE
VT5813OtherBCBS