Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 40.0091542 | VT |
Y | 2251X0800X | Physical Therapist - Orthopedic | 40.0091542 | VT |
NPI | 1205175379 |
---|---|
Provider Name | Dr. Sara St. Gelais |
First Address | Williston, VT 05495-8037 |
Second Address | Williston, VT 05495-8212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2013 |
Last Update Date | 26/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040.0091542 | VERMONT STATE LICENSE (01) | VT |