NPIMap

Organization Active NPI

Fairfax Family Physical Therapy, P.C.

  • Physical Therapist
  • Fairfax, VT
National Provider Identifier
1275797276
Registry record updated Jul 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0400000972 Issued in VT
Legal business name
FAIRFAX FAMILY PHYSICAL THERAPY, P.C.
Practice address
1282 Main St
Fairfax, VT 05454-9534
Phone
(802) 849-9308
NPI assigned
Jul 18, 2008
Last updated
Jul 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2008

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

Authorized official

Name
Krystal R Jenness, P.T.NPI 1114957131
Title
President
Phone
(802) 849-9308

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 0400000972 VT Primary

Addresses

Primary practice location

1282 Main St
Fairfax, VT 05454-9534

Mailing address

1282 Main St
Fairfax, VT 05454-9534
Phone (802) 849-9308

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150320001190 VT Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365519857 Receives reassigned benefits from 3 practitioners
Practice locations: Fairfax, VT

National Provider Directory

National Provider Directory

Locations

1282 Main St
Fairfax, VT 05454
Phone (802) 849-9308

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216339200000",
    "number": "1275797276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1282 MAIN ST",
            "city": "FAIRFAX",
            "state": "VT",
            "postal_code": "054549534",
            "telephone_number": "802-849-9308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1282 MAIN ST",
            "city": "FAIRFAX",
            "state": "VT",
            "postal_code": "054549534",
            "telephone_number": "802-849-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX FAMILY PHYSICAL THERAPY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2008-07-18",
        "status": "A",
        "authorized_official_last_name": "JENNESS",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "802-849-9308",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "0400000972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.