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General NPI Number Information
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NPI Number | 1710770599
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Entity Type | Individual
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Provider Name | ALEXA HERRERA CONDRY
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Gender | Female
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 99 MAPLE ST
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City | MIDDLEBURY
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State | VT
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Zip | 05753-1595
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Country | US
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Telephone | 802-989-4739
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Fax |
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Provider Business Mailing Address
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Address Line | 492 NORTH ST
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City | BRANDON
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State | VT
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Zip | 05733-8765
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Country | US
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Telephone | 802-989-4739
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 164.0001605
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License Number State | VT
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