Provider Demographics
NPI:1386804623
Name:ISLAND PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:ISLAND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CERRA-BELLINGHIRI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-372-4412
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:SOUTH HERO
Mailing Address - State:VT
Mailing Address - Zip Code:05486-0044
Mailing Address - Country:US
Mailing Address - Phone:802-372-4412
Mailing Address - Fax:
Practice Address - Street 1:564 ROUTE 2
Practice Address - Street 2:
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486-4307
Practice Address - Country:US
Practice Address - Phone:802-372-4412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty