Provider Demographics
NPI:1134169113
Name:DEE, MICHAEL CHRISTOPHER (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:DEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SAN REMO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6343
Mailing Address - Country:US
Mailing Address - Phone:802-865-0010
Mailing Address - Fax:802-865-0050
Practice Address - Street 1:23 SAN REMO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6343
Practice Address - Country:US
Practice Address - Phone:802-865-0010
Practice Address - Fax:802-865-0050
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009779Medicaid
VT7304860OtherCIGNA
VT18462OtherBC/BS
VT43V088OtherMVP
VT4694601OtherVT MANAGED CARE
VT4694601OtherVT MANAGED CARE