Provider Demographics
NPI:1275145906
Name:BERGERON-RADOUX, CATHERINE (DPT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BERGERON-RADOUX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 WILLISTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6491
Mailing Address - Country:US
Mailing Address - Phone:802-863-6662
Mailing Address - Fax:802-861-2224
Practice Address - Street 1:1775 WILLISTON RD STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6491
Practice Address - Country:US
Practice Address - Phone:802-863-6662
Practice Address - Fax:802-861-2224
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist