Provider Demographics
NPI:1750180618
Name:ELLIOTT, PHOEBE SUSANN
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:SUSANN
Last Name:ELLIOTT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHITTENDEN
Mailing Address - State:VT
Mailing Address - Zip Code:05763-9657
Mailing Address - Country:US
Mailing Address - Phone:802-353-6001
Mailing Address - Fax:
Practice Address - Street 1:11 RIVER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHITTENDEN
Practice Address - State:VT
Practice Address - Zip Code:05763-9657
Practice Address - Country:US
Practice Address - Phone:802-353-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer