Basic Information
| Provider Information | |||||||||
| NPI: | 1972661197 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPINE PHYSICAL THERAPY & SPORTS CARE, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 2493 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER CENTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05255 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027688369 | ||||||||
| FaxNumber: | 9147698077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | DEBITETTO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9148063788 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S.P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.