Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 040-002463 | VT |
NPI | 1164492161 |
---|---|
Provider Name | Ms. Maria Erb Thibault |
First Address | Burlington, VT 05401-1417 |
Second Address | Burlington, VT 05401-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 18/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1006926 | (05) | VT |