Provider Demographics
NPI:1396445268
Name:HOMETOWN PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:HOMETOWN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICKAELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:802-345-3538
Mailing Address - Street 1:125 PEAVINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05767-9669
Mailing Address - Country:US
Mailing Address - Phone:802-345-3538
Mailing Address - Fax:
Practice Address - Street 1:125 PEAVINE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05767-9669
Practice Address - Country:US
Practice Address - Phone:802-767-4295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty