Provider Demographics
NPI:1578001996
Name:DEVOID, JUSTIN
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:DEVOID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:691 WILLARD ROAD
Mailing Address - City:QUECHEE
Mailing Address - State:VT
Mailing Address - Zip Code:05059-0505
Mailing Address - Country:US
Mailing Address - Phone:802-738-4115
Mailing Address - Fax:
Practice Address - Street 1:691 WILLARD RD
Practice Address - Street 2:
Practice Address - City:QUECHEE
Practice Address - State:VT
Practice Address - Zip Code:05059-0505
Practice Address - Country:US
Practice Address - Phone:802-738-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer