Provider Demographics
NPI:1588637508
Name:POREMSKI, BROOKE ALISON
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ALISON
Last Name:POREMSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CHAMPLAIN CMNS
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1563
Mailing Address - Country:US
Mailing Address - Phone:802-524-1155
Mailing Address - Fax:802-524-2664
Practice Address - Street 1:2 CHAMPLAIN CMNS
Practice Address - Street 2:SUITE 4
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1563
Practice Address - Country:US
Practice Address - Phone:802-524-1155
Practice Address - Fax:802-524-2664
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04000030442251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006928Medicaid