Bennington Physical Therapy PC
Organization Active NPI Physical Therapist · Bennington, VT
NPI 1053393686 · NPPES record last updated Jun 30, 2008
Key facts
- NPI
- 1053393686
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- 108183 (VT)
- Legal business name
- BENNINGTON PHYSICAL THERAPY PC
- Practice address
- 328 Dewey St
Bennington, VT 05201-2225 - Phone
- (802) 447-2101
- Fax
- (802) 447-1902
- NPI assigned
- Nov 18, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey Joseph Videtto, PT
- Title
- President Physical Therapist
- Phone
- (802) 447-2101
Practitioners 7
-
Sindy Lee Hassig, MSPT
-
Terriann Whitman, PT
-
Paula Elaine Day, PT
-
Gail Obrien, P.T.
-
Timothy Lee Fauler, D.P.M.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040607000640 | VT | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 9830171404 |
Receives reassigned benefits from 5 practitioners Practice locations: Bennington, VT |
National Provider Directory
Locations
3 Main St
Hoosick Falls, NY 12090
Phone (518) 686-0286
328 Dewey St
Bennington, VT 05201
Phone (802) 447-2101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | 108183 | VT | Yes |
Addresses
Primary practice location
328 Dewey St
Bennington, VT 05201-2225
Mailing address
328 Dewey St
Bennington, VT 05201-2225
Phone (802) 447-2101
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BENN28712 | Other | VT | VT BCBS |
| 66326 | Other | VT | MOHAWK VALLEY PLAN |
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- Bennington Health and Rehabilitation Center LLC
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All providers in Bennington, VT · Physical Therapist in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.