Provider Demographics
NPI:1518638337
Name:FEDERSPIEL, MICHAELA ANNE (DPT, PT)
Entity type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:ANNE
Last Name:FEDERSPIEL
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:NY
Mailing Address - Zip Code:12936-0144
Mailing Address - Country:US
Mailing Address - Phone:413-441-1609
Mailing Address - Fax:
Practice Address - Street 1:3 CHAMPLAIN CMNS # 1
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1563
Practice Address - Country:US
Practice Address - Phone:802-524-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.01343112251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic