Provider Demographics
NPI:1134200207
Name:RATHBONE, LESLIE H (PT)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:H
Last Name:RATHBONE
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:PO BOX 1242
Mailing Address - Street 2:
Mailing Address - City:HARDWICK
Mailing Address - State:VT
Mailing Address - Zip Code:05843-1242
Mailing Address - Country:US
Mailing Address - Phone:802-472-9800
Mailing Address - Fax:802-472-9800
Practice Address - Street 1:39 CHURCH ST.
Practice Address - Street 2:ROOM 5&6
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-9800
Practice Address - Fax:802-472-9800
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT03036OtherCBA
VT785248OtherMVP
VT0002140OtherFLETCHER ALLEN PREFERRED
VT1011429Medicaid
VT29874OtherBLUE CROSS/BLUE SHIELD
VT1765159OtherCIGNA
VTRA VN3679Medicare ID - Type Unspecified