Provider Demographics
NPI:1619317872
Name:SARGENT, ELIZABETH CUDDY (ATC, LMBT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CUDDY
Last Name:SARGENT
Suffix:
Gender:F
Credentials:ATC, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7252 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255-9531
Mailing Address - Country:US
Mailing Address - Phone:802-362-1334
Mailing Address - Fax:
Practice Address - Street 1:7252 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9531
Practice Address - Country:US
Practice Address - Phone:802-362-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.00966722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer