Provider Demographics
NPI:1639482664
Name:VERMONT SPINEWORKS AND REHABILITATION
Entity Type:Organization
Organization Name:VERMONT SPINEWORKS AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEFKOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-388-3400
Mailing Address - Street 1:99 COURT ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-4448
Mailing Address - Country:US
Mailing Address - Phone:802-388-3400
Mailing Address - Fax:802-388-3441
Practice Address - Street 1:99 COURT ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-4448
Practice Address - Country:US
Practice Address - Phone:802-388-3400
Practice Address - Fax:802-388-3441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0009179208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty