Provider Demographics
NPI:1699868091
Name:FAMILY PHYSCIAL THERAPY, INC.
Entity type:Organization
Organization Name:FAMILY PHYSCIAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT, AT,C
Authorized Official - Phone:802-244-1140
Mailing Address - Street 1:137 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1515
Mailing Address - Country:US
Mailing Address - Phone:802-244-1140
Mailing Address - Fax:802-244-6851
Practice Address - Street 1:137 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1515
Practice Address - Country:US
Practice Address - Phone:802-244-1140
Practice Address - Fax:802-244-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVT0128OtherMVP PT PROVIDER OFFICE
VTCJ3697OtherMEDICARE RR
VT1010606Medicaid
VT4535416OtherCIGNA PT PROVIDER OFFICE
VT19023OtherBCBS PT PROVIDER OFFICE
VTCJ3697OtherMEDICARE RR