Provider Demographics
NPI:1902875636
Name:LOOK, JEFFREY MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:LOOK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BEARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9364
Mailing Address - Country:US
Mailing Address - Phone:802-233-3909
Mailing Address - Fax:
Practice Address - Street 1:905 ROOSEVELT HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-4475
Practice Address - Country:US
Practice Address - Phone:802-861-0111
Practice Address - Fax:802-861-2812
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT58817OtherBC/BS
VT6152701OtherFAHC/VMC PREFERRED APEX
VT384012OtherMVP
VT03014375OtherGREAT WEST
VT1011942Medicaid
VT030514375OtherCBA
VTDOL605524500OtherOWCP
VT384012OtherMVP