Individual
MARK SHERWOOD LIBBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
10606 RT 106 SOUTH, WOODSTOCK, VT 05091
(802) 457-4213
Mailing address
PO BOX 28, WOODSTOCK, VT 05091-0028
(802) 457-4213
(802) 457-9870
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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