Basic Information
| Provider Information | |||||||||
| NPI: | 1457674038 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDS REHABGYM INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 ROOSEVELT HIGHWAY | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054464475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028613600 | ||||||||
| FaxNumber: | 8028612812 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 ROOSEVELT HIGHWAY | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | COLCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054464475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028613600 | ||||||||
| FaxNumber: | 8028612812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2010 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | GUTWIN | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | BOARD OF DIRECTORS-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8028766000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 040-0002123 | VT | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 040-0001080 | VT | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 072-0051238 | VT | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 261QP2000X | 040-0002985 | VT | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.