Provider Demographics
NPI:1912119280
Name:DIANE K. GREENBERG, PT
Entity Type:Organization
Organization Name:DIANE K. GREENBERG, PT
Other - Org Name:BRISTOL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:KAREN
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-453-7200
Mailing Address - Street 1:167 MONKTON RD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-5045
Mailing Address - Country:US
Mailing Address - Phone:802-453-7200
Mailing Address - Fax:
Practice Address - Street 1:167 MONKTON RD
Practice Address - Street 2:SUITE 101B
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-5045
Practice Address - Country:US
Practice Address - Phone:802-453-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTBRIS00058197OtherBCBSVT
VTBRIS00058197OtherBCBSVT