Provider Demographics
NPI:1801333844
Name:MAYER-PLASSE, KRISTA JUDITH (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:JUDITH
Last Name:MAYER-PLASSE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MRS
Other - First Name:KRISTA
Other - Middle Name:JUDITH
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:170 GALLAGHER ACRES
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-9801
Mailing Address - Country:US
Mailing Address - Phone:413-883-4254
Mailing Address - Fax:
Practice Address - Street 1:137 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1579
Practice Address - Country:US
Practice Address - Phone:802-244-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0126066225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist