Provider Demographics
NPI:1295774370
Name:BATTENKILL AQUATICS AND PHYSICAL
Entity type:Organization
Organization Name:BATTENKILL AQUATICS AND PHYSICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:MATUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:802-681-7483
Mailing Address - Street 1:215 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1810
Mailing Address - Country:US
Mailing Address - Phone:802-681-7483
Mailing Address - Fax:802-681-7365
Practice Address - Street 1:215 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1810
Practice Address - Country:US
Practice Address - Phone:802-681-7483
Practice Address - Fax:802-681-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN3984Medicare PIN