Provider Demographics
NPI:1831455997
Name:CHOICE PHYSICAL THERAPY OF ST. ALBANS, LLC
Entity type:Organization
Organization Name:CHOICE PHYSICAL THERAPY OF ST. ALBANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:802-524-1155
Mailing Address - Street 1:2 CHAMPLAIN CMNS
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAINT ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-2049
Mailing Address - Country:US
Mailing Address - Phone:802-524-1155
Mailing Address - Fax:802-524-2664
Practice Address - Street 1:2 CHAMPLAIN CMNS
Practice Address - Street 2:SUITE 4
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-2049
Practice Address - Country:US
Practice Address - Phone:802-524-1155
Practice Address - Fax:802-524-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT041.0000456225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty