Provider Demographics
NPI:1952408148
Name:PHYSICAL THERAPY OPTIONS PLLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY OPTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:BASILIERE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-744-2076
Mailing Address - Street 1:5749 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05874-9737
Mailing Address - Country:US
Mailing Address - Phone:802-744-2076
Mailing Address - Fax:802-744-2757
Practice Address - Street 1:5749 LOOP RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:VT
Practice Address - Zip Code:05874-9737
Practice Address - Country:US
Practice Address - Phone:802-744-2076
Practice Address - Fax:802-744-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002235225100000X
VT0400002630225100000X
VT0410000278225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011239Medicaid
11325713OtherCAQH
VT1011239Medicaid