Provider Demographics
NPI:1790080364
Name:BOLL, ARIEL (DPT)
Entity Type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:BOLL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:SOUCIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 WINSLOW LN
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-2629
Mailing Address - Country:US
Mailing Address - Phone:603-674-9386
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:603-674-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist