Provider Demographics
NPI:1790741239
Name:PAQUETTE THERAPY CORPORATION
Entity Type:Organization
Organization Name:PAQUETTE THERAPY CORPORATION
Other - Org Name:ESSEX AQUATIC & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-871-5350
Mailing Address - Street 1:1 MARKET PL
Mailing Address - Street 2:UNIT 27 & 33
Mailing Address - City:ESSEX JCT
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2942
Mailing Address - Country:US
Mailing Address - Phone:802-871-5350
Mailing Address - Fax:802-871-5351
Practice Address - Street 1:1 MARKET PL
Practice Address - Street 2:UNIT 27 & 33
Practice Address - City:ESSEX JCT
Practice Address - State:VT
Practice Address - Zip Code:05452-2942
Practice Address - Country:US
Practice Address - Phone:802-871-5350
Practice Address - Fax:802-871-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006861Medicaid
VT1006861Medicaid