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General NPI Number Information
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NPI Number | 1942257977
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Entity Type | Individual
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Provider Name | JENNIFER LEGACY PT
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 31 MIDDLE ST
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City | LYNDONVILLE
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State | VT
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Zip | 05851
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Country | US
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Telephone | 802-626-4224
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Fax | 802-626-5042
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Provider Business Mailing Address
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Address Line | PO BOX 1346
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City | LYNDONVILLE
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State | VT
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Zip | 05851-1346
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Country | US
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Telephone | 802-626-4224
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Fax | 802-626-5042
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 040-003546
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License Number State | VT
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