Provider Demographics
NPI:1851517791
Name:BASILIERE, REBECCA JANE (PT)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JANE
Last Name:BASILIERE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 INDIAN POINT STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-5555
Mailing Address - Country:US
Mailing Address - Phone:802-334-5858
Mailing Address - Fax:802-334-8270
Practice Address - Street 1:241 INDIAN POINT STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5555
Practice Address - Country:US
Practice Address - Phone:802-334-5858
Practice Address - Fax:802-334-8270
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011239Medicaid
VT1011239Medicaid