Provider Demographics
NPI:1093911968
Name:MARCUSSEN, KRISTINA MARGARET (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARGARET
Last Name:MARCUSSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MCCLELLAN FARM RD
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489-9421
Mailing Address - Country:US
Mailing Address - Phone:773-458-0183
Mailing Address - Fax:
Practice Address - Street 1:21 GREGORY DR
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6080
Practice Address - Country:US
Practice Address - Phone:802-658-0949
Practice Address - Fax:802-658-1436
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003702225100000X
NC12405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist