Organization
PHYSIALIGN LLC
Active
Other names
PhysiAlign
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAUREN WEDAM PT, DPT (AUTHORIZED AGENT)
(802) 318-0581
Entity
Organization
Contact information
Practice address
1233 SHELBURNE RD STE 190, SOUTH BURLINGTON, VT 05403-7733
(802) 318-0581
(802) 448-5951
Mailing address
PO BOX 64823, BURLINGTON, VT 05406-4823
(802) 318-0581
(802) 448-5951
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040.0066530
VT LICENCE NUMBER
VT
Enumeration date
04/15/2019
Last updated
12/26/2019
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