Provider Demographics
NPI:1245303601
Name:MAIN, HUGH (PT)
Entity type:Individual
Prefix:MR
First Name:HUGH
Middle Name:
Last Name:MAIN
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 1:825 E MANCHESTER ROAD
Mailing Address - Street 2:PO BOX 407
Mailing Address - City:MANCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05254-0407
Mailing Address - Country:US
Mailing Address - Phone:802-362-1692
Mailing Address - Fax:
Practice Address - Street 1:3800 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254-0407
Practice Address - Country:US
Practice Address - Phone:802-362-4004
Practice Address - Fax:802-362-4004
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0000747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN 3295Medicaid
VTS9671OtherBCBS
VT410052OtherMVP
VTVN 3295Medicaid