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General NPI Number Information
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NPI Number | 1932066933
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Entity Type | Individual
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Provider Name | MELANIE CUSTODIO
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Gender | Female
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 652 GRANGER RD
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City | BARRE
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State | VT
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Zip | 05641-5363
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Country | US
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Telephone | 508-463-5998
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 VT 14 N
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City | EAST MONTPELIER
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State | VT
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Zip | 05651-4026
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 040.0134012
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License Number State | VT
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