Healthcare Provider Details

I. General information

NPI: 1912541491
Provider Name (Legal Business Name): HOYT C BINGHAM LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 PALMER COURT
WILDER VT
05088-0506
US

IV. Provider business mailing address

4429 VT ROUTE 14
S ROYALTON VT
05068-5090
US

V. Phone/Fax

Practice location:
  • Phone: 802-299-5724
  • Fax:
Mailing address:
  • Phone: 802-299-5724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6107
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: