Provider Demographics
NPI:1891749479
Name:CHOICE PHYSICAL THERAPY OF ST ALBANS LLC
Entity Type:Organization
Organization Name:CHOICE PHYSICAL THERAPY OF ST ALBANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-524-1155
Mailing Address - Street 1:3 CHAMPLAIN CMNS
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1563
Mailing Address - Country:US
Mailing Address - Phone:802-524-1155
Mailing Address - Fax:802-524-2664
Practice Address - Street 1:3 CHAMPLAIN CMNS
Practice Address - Street 2:SUITE 1
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1563
Practice Address - Country:US
Practice Address - Phone:802-524-1155
Practice Address - Fax:802-524-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59086OtherBCBS GROUP NUMBER
VTOVN3037Medicaid
VTOVN3037Medicaid