Provider Demographics
NPI:1285862920
Name:EVERETT, DIANE M (PT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:EVERETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:331 OLCOTT DRIVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:WILDER
Mailing Address - State:VT
Mailing Address - Zip Code:05088-9800
Mailing Address - Country:US
Mailing Address - Phone:802-295-7333
Mailing Address - Fax:802-295-0058
Practice Address - Street 1:331 OLCOTT DR
Practice Address - Street 2:UNIT 2
Practice Address - City:WILDER
Practice Address - State:VT
Practice Address - Zip Code:05088-9800
Practice Address - Country:US
Practice Address - Phone:802-295-7333
Practice Address - Fax:802-295-0058
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT040-0002231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist