Provider Demographics
NPI:1336361799
Name:MIDDLEBURY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MIDDLEBURY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-398-2700
Mailing Address - Street 1:295 COLONIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05733
Mailing Address - Country:US
Mailing Address - Phone:802-398-2700
Mailing Address - Fax:802-398-2702
Practice Address - Street 1:295 COLONIAL DRIVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05733
Practice Address - Country:US
Practice Address - Phone:802-398-2700
Practice Address - Fax:802-398-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTMIDD00068509OtherBCBSVT
VTMIDD00068509OtherBCBSVT