Provider Demographics
NPI:1538463740
Name:HUNGER MOUNTIAN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:HUNGER MOUNTIAN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-999-8670
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05667-0484
Mailing Address - Country:US
Mailing Address - Phone:802-999-8670
Mailing Address - Fax:
Practice Address - Street 1:157 TOWNE AVE.
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:VT
Practice Address - Zip Code:05667
Practice Address - Country:US
Practice Address - Phone:802-999-8670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty