Provider Demographics
NPI:1316055924
Name:MANSFIELD PHYSICAL THERAPY LIMITED PARTNERSHIP
Entity type:Organization
Organization Name:MANSFIELD PHYSICAL THERAPY LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS. OFC. MGR.
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LACAILLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-879-8300
Mailing Address - Street 1:21 ESSEX WAY
Mailing Address - Street 2:SUITE 116
Mailing Address - City:ESSEX JCT.
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-879-8300
Mailing Address - Fax:803-879-9300
Practice Address - Street 1:21 ESSEX WAY
Practice Address - Street 2:SUITE 1116
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-3385
Practice Address - Country:US
Practice Address - Phone:802-879-8300
Practice Address - Fax:803-879-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTMAVN2669Medicare PIN