Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 040.0111632 | VT |
N | 2251S0007X | Physical Therapist - Sports | 040.0111632 | VT |
NPI | 1245616366 |
---|---|
Provider Name | Regan Dewhirst |
First Address | South Burlington, VT 05403-6306 |
Second Address | South Burlington, VT 05403-6306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2015 |
Last Update Date | 31/07/2015 |