Provider Demographics
NPI:1427072081
Name:WHITEHORNE, DARCI LYNN (MSPT)
Entity type:Individual
Prefix:
First Name:DARCI
Middle Name:LYNN
Last Name:WHITEHORNE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:DARCI
Other - Middle Name:LYNN
Other - Last Name:MUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:5 ALBERT CREE DR
Mailing Address - Street 2:VERMONT SPORTS MEDICINE CENTER
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-775-1300
Mailing Address - Fax:802-773-9300
Practice Address - Street 1:279 BUSINESS ROUTE 4 STE 1
Practice Address - Street 2:
Practice Address - City:CENTER RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05736-9701
Practice Address - Country:US
Practice Address - Phone:802-775-4372
Practice Address - Fax:802-775-4918
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00069063OtherBLUE CROSS BLUE SHIELD VT
VT1012361Medicaid
4147111OtherMVP
7330439OtherAETNA
4147111OtherMVP
00069063OtherBLUE CROSS BLUE SHIELD VT