Provider Demographics
NPI:1932353737
Name:UNIVERSITY OF VERMONT MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERSITY OF VERMONT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORRIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-343-7503
Mailing Address - Street 1:4 KARSYNREECE LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-3681
Mailing Address - Country:US
Mailing Address - Phone:802-343-7503
Mailing Address - Fax:802-871-5489
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-9852
Practice Address - Fax:802-847-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400067743225100000X
VT040.0067743261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty