Provider Demographics
NPI:1699806869
Name:NELSON, LEONIE BURNS (PT)
Entity Type:Individual
Prefix:MS
First Name:LEONIE
Middle Name:BURNS
Last Name:NELSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LINCOLN ST
Mailing Address - Street 2:CHAMPLAIN PHYSICAL THERAPY
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3235
Mailing Address - Country:US
Mailing Address - Phone:802-878-9513
Mailing Address - Fax:802-878-9962
Practice Address - Street 1:67 LINCOLN ST
Practice Address - Street 2:CHAMPLAIN PHYSICAL THERAPY
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3235
Practice Address - Country:US
Practice Address - Phone:802-878-9513
Practice Address - Fax:802-878-9962
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0000844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008030Medicaid
VT06529618OtherBLUE CROSS BLUE SHIELD
VT06529618OtherBLUE CROSS BLUE SHIELD