Provider Demographics
NPI:1518245836
Name:CULLY, PHILIPPA EDWARDS (PHILIPPA CULLY)
Entity Type:Individual
Prefix:
First Name:PHILIPPA
Middle Name:EDWARDS
Last Name:CULLY
Suffix:
Gender:F
Credentials:PHILIPPA CULLY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S END RD
Mailing Address - Street 2:
Mailing Address - City:EAST DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05253-9753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:VT
Practice Address - Zip Code:05251
Practice Address - Country:US
Practice Address - Phone:802-375-3686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0870064275225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist