Provider Demographics
NPI:1801808951
Name:MANSFIELD, CRYSTAL M
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LINDEN STREET
Mailing Address - Street 2:C/O PHYSICAL THERAPY SERVICES OF BRATTLEBORO INC
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301
Mailing Address - Country:US
Mailing Address - Phone:802-254-4699
Mailing Address - Fax:802-257-1985
Practice Address - Street 1:56 LINDEN STREET
Practice Address - Street 2:C/O PHYSICAL THERAPY SERVICES OF BRATTLEBORO INC
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301
Practice Address - Country:US
Practice Address - Phone:802-254-4699
Practice Address - Fax:802-257-1985
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT072-0000034225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009942Medicaid
VT00029512OtherBLUE CROSS BLUE SHIELD
VT00029512OtherBLUE CROSS BLUE SHIELD