Healthcare Provider Details

I. General information

NPI: 1801808951
Provider Name (Legal Business Name): CRYSTAL M MANSFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 LINDEN STREET C/O PHYSICAL THERAPY SERVICES OF BRATTLEBORO INC
BRATTLEBORO VT
05301
US

IV. Provider business mailing address

56 LINDEN STREET C/O PHYSICAL THERAPY SERVICES OF BRATTLEBORO INC
BRATTLEBORO VT
05301
US

V. Phone/Fax

Practice location:
  • Phone: 802-254-4699
  • Fax: 802-257-1985
Mailing address:
  • Phone: 802-254-4699
  • Fax: 802-257-1985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number072-0000034
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: