Organization
BENNINGTON PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY JOSEPH VIDETTO PT (PRESIDENT PHYSICAL THERAPIST)
(802) 447-2101
Entity
Organization
Contact information
Practice address
328 DEWEY ST, BENNINGTON, VT 05201-2225
(802) 447-2101
(802) 447-1902
Mailing address
328 DEWEY ST, BENNINGTON, VT 05201-2225
(802) 447-2101
(802) 447-1902
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
108183
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
66326
MOHAWK VALLEY PLAN
VT
01
—
BENN28712
VT BCBS
VT
Enumeration date
11/18/2005
Last updated
06/30/2008
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