Provider Demographics
NPI:1639374556
Name:ENGELS, WILLIAM CHARLES (PT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:ENGELS
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:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:VT
Mailing Address - Zip Code:05161-0238
Mailing Address - Country:US
Mailing Address - Phone:802-824-3195
Mailing Address - Fax:
Practice Address - Street 1:25 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-3050
Practice Address - Country:US
Practice Address - Phone:802-886-2172
Practice Address - Fax:802-886-2174
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-00037192251X0800X
NY03444-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003444-1OtherPHYSICAL THERAPY
VT040-0003719OtherPHYSICAL THERAPY