Provider Demographics
NPI:1487733176
Name:DECAROLIS, KATHERINE (PT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DECAROLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KENNEDY DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7152
Mailing Address - Country:US
Mailing Address - Phone:802-863-3323
Mailing Address - Fax:802-863-3288
Practice Address - Street 1:1 KENNEDY DR UNIT 3
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7152
Practice Address - Country:US
Practice Address - Phone:802-863-3323
Practice Address - Fax:802-863-3288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008410Medicaid
VT00007287OtherBC/BS
VT43V082OtherMVP
VT2729233OtherCIGNA
VT1008410Medicaid