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Individual
MARK SHERWOOD LIBBY
Active
Individual
MARK SHERWOOD LIBBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
040 0003101
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38849
BLUE CROSS/BLUE SHIELD
VT
01
—
439910
MVP
VT
05
—
OVN1901
—
VT
Enumeration date
06/27/2006
Last updated
04/30/2019
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