Provider Demographics
NPI:1457674038
Name:KIDS REHABGYM INC.
Entity Type:Organization
Organization Name:KIDS REHABGYM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD OF DIRECTORS-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:802-876-6000
Mailing Address - Street 1:905 ROOSEVELT HIGHWAY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-4475
Mailing Address - Country:US
Mailing Address - Phone:802-861-3600
Mailing Address - Fax:802-861-2812
Practice Address - Street 1:905 ROOSEVELT HIGHWAY
Practice Address - Street 2:SUITE 115
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4475
Practice Address - Country:US
Practice Address - Phone:802-861-3600
Practice Address - Fax:802-861-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002123225100000X
VT040-0001080225100000X
VT072-0051238225X00000X
VT040-0002985261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty