Provider Demographics
NPI:1972542520
Name:DEE, JUSTINE MCCUEN (PT, MS)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MCCUEN
Last Name:DEE
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23 SAN REMO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6343
Mailing Address - Country:US
Mailing Address - Phone:802-865-0010
Mailing Address - Fax:802-865-0050
Practice Address - Street 1:23 SAN REMO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6343
Practice Address - Country:US
Practice Address - Phone:802-865-0010
Practice Address - Fax:802-865-0050
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0002382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT29689OtherBC/BS
VT363001OtherMVP
VT1006918Medicaid
VT4694501OtherVT MANAGED CARE
VT7304860OtherCIGNA
VT1006918Medicaid