Provider Demographics
NPI:1861705766
Name:POULIN, KANDI (DPT)
Entity type:Individual
Prefix:MISS
First Name:KANDI
Middle Name:
Last Name:POULIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KANDI
Other - Middle Name:
Other - Last Name:PARRISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404
Mailing Address - Country:US
Mailing Address - Phone:802-864-3785
Mailing Address - Fax:802-864-0274
Practice Address - Street 1:321 MAIN STREET
Practice Address - Street 2:SUITE D
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404
Practice Address - Country:US
Practice Address - Phone:802-864-3785
Practice Address - Fax:802-864-0274
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400067746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist