Individual
JACLYN A GAMACHE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1 SCALE AVE, BUILDING 18, SUITE 32, RUTLAND, VT 05701-4452
(802) 855-8068
(802) 855-8436
Mailing address
794 HITCHCOCK RD, PITTSFORD, VT 05763-9544
(207) 632-4030
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
040.0121765
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13865603
CAQH PROVIDER ID
VT
Enumeration date
08/01/2016
Last updated
08/01/2016
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