Provider Demographics
NPI:1174745038
Name:DE BITETTO, JOHN R (MSPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DE BITETTO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2493
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-2493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3800 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254
Practice Address - Country:US
Practice Address - Phone:802-768-8369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.01020922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1845988004OtherUNITED HEALTHCARE
NY113566467OtherMAGNACARE
NY12440OtherHUDSON HEALTH PLAN
NY2814489OtherAETNA
NY61084OtherGHI HMO
NY6C2388OtherHEALTH NET
NY5901197OtherCIGNA PPO
NY6604216OtherGHI PPO
NY0010520OtherCIGNA HMO
NY113566467OtherPOMCO
NY38086POtherHIP
NYP2565190OtherOXFORD
NY113566467-02Other1199 NAT'L BENEFIT FUND
NYQC82210OtherBLUE CROSS BLUE SHIELD
NY61084OtherGHI HMO