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Organization
THE REHABGYM INC
Active
Organization
THE REHABGYM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN LEE JAQUES (AUTHORIZED OFFICIAL/BILLING MANAGER)
(802) 565-1422
Entity
Organization
Contact information
Practice address
373 BLAIR PARK RD UNIT 100, WILLISTON, VT 05495-8077
(802) 876-6000
Mailing address
373 BLAIR PARK RD UNIT 100, WILLISTON, VT 05495-8077
(802) 876-6000
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00059461
BCBS GROUP #
VT
05
—
1009754
—
VT
01
—
200070257
MVP GROUP #
VT
01
—
CIGNA
GROUP #
VT
01
—
DOL605524500
OWCP
VT
Enumeration date
02/07/2007
Last updated
05/10/2018
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