Provider Demographics
NPI:1528375979
Name:TODD HOLT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:TODD HOLT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTERS PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:802-461-4567
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05863-0072
Mailing Address - Country:US
Mailing Address - Phone:802-461-4567
Mailing Address - Fax:802-230-4566
Practice Address - Street 1:687 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:VT
Practice Address - Zip Code:05046-9674
Practice Address - Country:US
Practice Address - Phone:802-461-4567
Practice Address - Fax:802-230-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003324225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty