NPIMap

Organization Active NPI

Poulin Performance, Inc.

  • Physical Therapist
  • South Burlington, VT
National Provider Identifier
1174553283
Registry record updated Oct 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
040-0002746 Issued in VT
Legal business name
POULIN PERFORMANCE, INC.
Practice address
21 Gregory Dr
Suite 120
South Burlington, VT 05403-6080
Phone
(802) 658-0949
Fax
(802) 658-1436
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Cynthia Audette Critchlow, CAPPM
Title
Practice Administrator
Phone
(802) 656-0949

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 040-0002746 VT Primary

Addresses

Primary practice location

21 Gregory Dr
Suite 120
South Burlington, VT 05403-6080

Mailing address

PO Box 486
Williston, VT 05495-0486
Phone (802) 658-0949

Other identifiers 3

IdentifierTypeStateIssuer
0632746OtherUTCIGNA
1009260MedicaidVT
59089OtherVTBCBS

Other names 1

  • Poulin Performance and Rehabilitation Center Doing business as

National Provider Directory

National Provider Directory

Locations

70 Farrell St
S Burlington, VT 05403

21 Gregory Dr
Ste 120
South Burlington, VT 05403

271 Moulton Rd
Waitsfield, VT 05673
Phone (802) 496-4292

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1174553283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 486",
            "city": "WILLISTON",
            "state": "VT",
            "postal_code": "054950486",
            "telephone_number": "802-658-0949",
            "fax_number": "802-658-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GREGORY DR",
            "address_2": "SUITE 120",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054036080",
            "telephone_number": "802-658-0949",
            "fax_number": "802-658-1436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POULIN PERFORMANCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "CRITCHLOW",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "AUDETTE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "802-656-0949",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CAPPM"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "040-0002746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0632746",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009260",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "59089",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poulin Performance and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Burlington, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.