Organization
THE LIFESTYLE ATHLETE PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CASEY BACZEWSKI PT (OWNER)
(802) 338-1406
Entity
Organization
Contact information
Practice address
520 AVENUE D, WILLISTON, VT 05495-7136
(802) 388-2318
(802) 399-2505
Mailing address
PO BOX 8381, ESSEX, VT 05451-8381
(802) 338-1406
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
04/13/2020
Last updated
11/02/2024
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