NPIMap

Organization Active NPI

Vermont Sports Medicine Center

  • Occupational Therapist
  • Rutland, VT
National Provider Identifier
1730103300
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
VERMONT SPORTS MEDICINE CENTER
Practice address
5 Albert Cree Dr
Rutland, VT 05701
Phone
(802) 775-1300
Fax
(802) 773-9300
NPI assigned
Jul 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Maureen Corey GibeaultNPI 1447261557
Title
Director
Phone
(802) 775-1300

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary

Addresses

Primary practice location

5 Albert Cree Dr
Rutland, VT 05701

Mailing address

5 Albert Cree Dr
Rutland, VT 05701
Phone (802) 775-1300

Other identifiers 4

IdentifierTypeStateIssuer
4471OtherBLUE CROSS OF VT
OVN2225MedicaidVT
9690007OtherCIGNA
50922OtherMVP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331000766 VT Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365334810 Receives reassigned benefits from 14 practitioners
Practice locations: Brandon, VT; Castleton, VT; Killington, VT; Rutland, VT

National Provider Directory

National Provider Directory

Locations

7252 Main St
Ste A
Manchester Center, VT 05255
Phone (802) 367-3026

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1730103300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 ALBERT CREE DR",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "05701",
            "telephone_number": "802-775-1300",
            "fax_number": "802-773-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 ALBERT CREE DR",
            "city": "RUTLAND",
            "state": "VT",
            "postal_code": "05701",
            "telephone_number": "802-775-1300",
            "fax_number": "802-773-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERMONT SPORTS MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-27",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "GIBEAULT",
        "authorized_official_first_name": "MAUREEN",
        "authorized_official_middle_name": "COREY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "802-775-1300"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF VT",
            "identifier": "4471",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN2225",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "9690007",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "50922",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rutland, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.