Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 0400002466 | VT |
NPI | 1487762696 |
---|---|
Provider Name | Susan Cromwell |
First Address | Underhill, VT 05489-9369 |
Second Address | Colchester, VT 05446-3007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |