Provider Demographics
NPI:1881612315
Name:COHEN, MINDY LEE (MS PT)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LEE
Last Name:COHEN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15 CONIFER CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5915
Mailing Address - Country:US
Mailing Address - Phone:802-999-7101
Mailing Address - Fax:
Practice Address - Street 1:145 PINE HAVEN SHORES RD STE 1000
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7812
Practice Address - Country:US
Practice Address - Phone:802-304-4048
Practice Address - Fax:802-658-1436
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT3179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006922Medicaid