Provider Demographics
NPI:1023456811
Name:CORE INTEGRATION VERMONT PLLC
Entity type:Organization
Organization Name:CORE INTEGRATION VERMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HASEGAWA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-257-0810
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05344-0325
Mailing Address - Country:US
Mailing Address - Phone:802-257-0810
Mailing Address - Fax:
Practice Address - Street 1:20 TECHNOLOGY DR
Practice Address - Street 2:SUITE 8
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-9181
Practice Address - Country:US
Practice Address - Phone:802-257-0810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty