Individual
MR. GEOFFREY RD ILLINGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
36 ADAMS ST, WESTMINSTER, VT 05158-9706
(802) 463-4725
Mailing address
36 ADAMS ST, WESTMINSTER, VT 05158-9706
(802) 463-4725
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
040-0002739
VT
2255A2300X
Athletic Trainer
104-0000015
VT
Other
Enumeration date
03/02/2007
Last updated
08/22/2007
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