Provider Demographics
NPI:1649260878
Name:PHYSICAL THERAPY SERVICES OF BRATTLEBORO INC
Entity type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF BRATTLEBORO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-254-4699
Mailing Address - Street 1:30 HARRIS PLACE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-254-4699
Mailing Address - Fax:802-257-1985
Practice Address - Street 1:30 HARRIS PLACE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-254-4699
Practice Address - Fax:802-257-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50Y305600VT01OtherPRIVATE INSURANCE (BCBS)
7001366-001OtherPRIVATE INSURANCE (CIGNA)
VTOVN2126Medicaid
VT48740OtherPRIVATE INSURANCE (BCBS)
200055371OtherPRIVATE INSURANCE (MVP)
NH50Y305600VT01OtherPRIVATE INSURANCE (BCBS)
CG4500Medicare ID - Type UnspecifiedRAILROAD MEDICARE