Provider Demographics
NPI:1912053554
Name:PINNACLE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:PINNACLE PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWEET
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-253-2273
Mailing Address - Street 1:1878 MOUNTAIN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4776
Mailing Address - Country:US
Mailing Address - Phone:802-253-2273
Mailing Address - Fax:802-253-7754
Practice Address - Street 1:1878 MOUNTAIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4776
Practice Address - Country:US
Practice Address - Phone:802-253-2273
Practice Address - Fax:802-253-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1639180672OtherINDIV NPI NUMBER
VT1760588081OtherIND NPI NUMBER
VT1011043Medicaid
VTVN2580Medicare ID - Type UnspecifiedINDIV MEDICARE NUMBER
VTVN1450Medicare ID - Type UnspecifiedINDIV MEDICARE NUMBER