Provider Demographics
NPI:1780643122
Name:FOLSOM, DEIRDRE M (PT WCS)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:M
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:PT WCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MALLETTS BAY AVE
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1959
Mailing Address - Country:US
Mailing Address - Phone:802-847-0080
Mailing Address - Fax:802-847-0310
Practice Address - Street 1:32 MALLETTS BAY AVE
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1959
Practice Address - Country:US
Practice Address - Phone:802-847-0080
Practice Address - Fax:802-847-0310
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT11475616OtherCAQH
VT5852001OtherFAHC
VT6002139OtherMVP
VT1013234Medicaid
58710OtherBCBS
VT58710OtherTVHP
58710OtherBCBS