Individual
KRYSTAL JENNESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1282 MAIN ST, FAIRFAX, VT 05454-9534
(802) 849-9308
(802) 849-9752
Mailing address
303 LLOYD RD, FAIRFAX, VT 05454-4403
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0400000972
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006936
—
VT
01
—
29696
BCBS OF VT PROVIDER #
VT
01
—
364674
MVP PROVIDER #
VT
01
—
9150484
CIGNA PROVIDER #
VT
Enumeration date
07/04/2006
Last updated
07/08/2007
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