Provider Demographics
NPI:1851463434
Name:PERSONALIZED PT, PC
Entity Type:Organization
Organization Name:PERSONALIZED PT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISSLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-888-5230
Mailing Address - Street 1:PO BOX 1485
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-1485
Mailing Address - Country:US
Mailing Address - Phone:802-888-5230
Mailing Address - Fax:
Practice Address - Street 1:71 LOWER MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009314Medicaid
VTVN3288Medicare ID - Type Unspecified