Healthcare Provider Details

I. General information

NPI: 1093531543
Provider Name (Legal Business Name): LIV SKORSTAD NMT,CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 CENTER RD
HARDWICK VT
05843-9530
US

IV. Provider business mailing address

2348 CENTER RD
HARDWICK VT
05843-9530
US

V. Phone/Fax

Practice location:
  • Phone: 802-730-4380
  • Fax:
Mailing address:
  • Phone: 802-730-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number164.0000058
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: