Provider Demographics
NPI:1912211863
Name:OTTAUQUECHEE PHYSICAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:OTTAUQUECHEE PHYSICAL THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MAYOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-457-3215
Mailing Address - Street 1:442 WOODSTOCK RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-9794
Mailing Address - Country:US
Mailing Address - Phone:802-457-3215
Mailing Address - Fax:802-457-6118
Practice Address - Street 1:442 WOODSTOCK RD STE 3A
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-9794
Practice Address - Country:US
Practice Address - Phone:802-457-3215
Practice Address - Fax:802-457-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty