Provider Demographics
NPI:1386255925
Name:DEGRE, MYRA GENE ANN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:GENE ANN
Last Name:DEGRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DERBY LINE
Mailing Address - State:VT
Mailing Address - Zip Code:05830-9302
Mailing Address - Country:US
Mailing Address - Phone:802-673-8315
Mailing Address - Fax:
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:
Practice Address - City:DERBY LINE
Practice Address - State:VT
Practice Address - Zip Code:05830-9302
Practice Address - Country:US
Practice Address - Phone:802-673-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2020-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty