Organization
VINEYARD COMPLEMENTARY MEDICINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN A SANFORD PT (PRESIDENT/CEO)
(508) 693-3800
Entity
Organization
Contact information
Practice address
238 EDGARTOWN VINEYARD HAVEN ROAD, UNIT 1, EDGARTOWN, MA 02539-6932
(508) 693-3800
(508) 693-7473
Mailing address
PO BOX 1760, EDGARTOWN, MA 02539-1760
(508) 693-3800
(508) 693-7473
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
687
MA
261QX0100X
Occupational Medicine Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA52541
HPHC
—
01
—
Y61445
BCBS OF MA
MA
Enumeration date
11/03/2006
Last updated
12/01/2020
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