Provider Demographics
NPI:1033571971
Name:PERSHOUSE, KATHARINE (LAC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:PERSHOUSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:THETFORD CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05075-0277
Mailing Address - Country:US
Mailing Address - Phone:802-785-2503
Mailing Address - Fax:
Practice Address - Street 1:3843 ROUTE 113
Practice Address - Street 2:
Practice Address - City:THETFORD CENTER
Practice Address - State:VT
Practice Address - Zip Code:05075-0277
Practice Address - Country:US
Practice Address - Phone:802-785-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091.0000026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist