Provider Demographics
NPI:1760588081
Name:SWEET, PHILIP L (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:SWEET
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 MOUNTAIN ROAD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05677
Mailing Address - Country:US
Mailing Address - Phone:802-253-2273
Mailing Address - Fax:802-253-7754
Practice Address - Street 1:1878 MOUNTAIN ROAD
Practice Address - Street 2:SUITE #1
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05677
Practice Address - Country:US
Practice Address - Phone:802-253-2273
Practice Address - Fax:802-253-7754
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VNI450Medicaid
VT28255OtherBCBS
VT0VNI450Medicaid