Provider Demographics
NPI:1285058859
Name:JANCAITIS, JACQUELINE (DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:JANCAITIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAWTHORNE ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8212
Mailing Address - Country:US
Mailing Address - Phone:802-876-6000
Mailing Address - Fax:
Practice Address - Street 1:30 HAWTHORNE ST
Practice Address - Street 2:SUITE 20
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8212
Practice Address - Country:US
Practice Address - Phone:802-876-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400100826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist