Green Mountain Rehabilitation & Sports Medicine LLC
Organization Active NPI Orthopedic Physical Therapist · Burlington, VT
NPI 1689705139 · NPPES record last updated Nov 8, 2012
Key facts
- NPI
- 1689705139
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- 040-0003248 (VT)
- Legal business name
- GREEN MOUNTAIN REHABILITATION & SPORTS MEDICINE LLC
- Practice address
- 90 Main St
Burlington, VT 05401-8419 - Phone
- (802) 861-6700
- Fax
- (802) 861-2143
- NPI assigned
- Mar 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Eric Elsinger, MSPT
- Title
- Member
- Phone
- (802) 861-6700
Practitioners 5
-
Eric Elsinger, PT
-
Andrew Thomas Bowen, P.T.
-
Christine Ann Hagan, DPT
-
Ria Lian Conrad, PT, DPT
-
Harrison Sullivan, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071207000245 | VT | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 4789773292 |
Receives reassigned benefits from 5 practitioners Practice locations: Burlington, VT |
National Provider Directory
Locations
90 Main St
Burlington, VT 05401
Phone (802) 861-6700
85 Main St
Burlington, VT 05401
Phone (802) 861-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist |
2251X0800X | 040-0003248 | VT | Yes |
| Orthopedic Physical Therapist |
2251X0800X | 040-0003401 | VT |
Addresses
Primary practice location
90 Main St
Burlington, VT 05401-8419
Mailing address
90 Main St
Burlington, VT 05401-8419
Phone (802) 861-6700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4149377 | Other | VT | MVP |
| 1386659100 | Other | VT | NPI |
| 5268301 | Other | VT | FAP |
| 6000628 | Other | VT | MVP |
| 9554226 | Other | VT | CIGNA |
| 00049991 | Other | VT | BCBS |
| 1007705 | Medicaid | VT | |
| 48616 | Other | VT | TVHP |
| 5273607 | Other | VT | FAP |
| 00048616 | Other | VT | BCBS |
| 1009289 | Medicaid | VT | |
| 1992711923 | Other | VT | NPI |
| 6245674 | Other | VT | CIGNA |
| 69511 | Other | VT | TVHP |
Other providers in Burlington, VT
- Greater Burlington Young Men'S Christian Association, Inc.
- Green Mountain Aid, Inc.
- Green Mountain Behavioral Medicine LLC
- Green Mountain Endodontics, PLLC
- Green Mountain Internal Medicine PLC
- Andrea Elizabeth Green
- Curtis Green
- Hannah E. Green
- Joshua D. Green
- Kayla Mae Green
All providers in Burlington, VT · Orthopedic 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 Nov 8, 2012. 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.