Provider Demographics
NPI:1871275263
Name:MERCIA, JEFF (PT)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:MERCIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:289 HURRICANE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-2092
Mailing Address - Country:US
Mailing Address - Phone:802-655-7575
Mailing Address - Fax:802-655-1115
Practice Address - Street 1:289 HURRICANE LN STE 102
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2092
Practice Address - Country:US
Practice Address - Phone:802-655-7575
Practice Address - Fax:802-655-1115
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT040.0134616225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist