Provider Demographics
NPI:1447241476
Name:KINDOPP, MICHAEL DAMON (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAMON
Last Name:KINDOPP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-2964
Mailing Address - Country:US
Mailing Address - Phone:802-254-4699
Mailing Address - Fax:802-257-1985
Practice Address - Street 1:56 LINDEN ST
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2964
Practice Address - Country:US
Practice Address - Phone:802-254-4699
Practice Address - Fax:802-257-1985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00028991OtherPRIVATE INSURANCE (BCBS)
NH08Y002461VT01OtherPRIVATE INSURANCE (BCBS)
NH30391209Medicaid
VTOVN1995Medicaid
43427OtherPRIVATE INSURANCE (MVP)
NH08Y002461VT01OtherPRIVATE INSURANCE (BCBS)