Provider Demographics
NPI:1497969331
Name:TOMASELLI, ANTHONY J (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:J
Last Name:TOMASELLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:TOMASELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:235 LAKEMONT RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9690
Mailing Address - Country:US
Mailing Address - Phone:802-334-8558
Mailing Address - Fax:802-334-8559
Practice Address - Street 1:235 LAKEMONT RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9690
Practice Address - Country:US
Practice Address - Phone:802-334-8558
Practice Address - Fax:802-334-8559
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003243225100000X
NH2366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist