Individual
JENNIFER LEGACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
31 MIDDLE ST, LYNDONVILLE, VT 05851
(802) 626-4224
(802) 626-5042
Mailing address
PO BOX 1346, LYNDONVILLE, VT 05851-1346
(802) 626-4224
(802) 626-5042
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
040-003546
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003546
VT MANAGED CARE
—
05
—
1011382
—
VT
01
—
398447
MVP
VT
01
—
65837
BC/BS
VT
Enumeration date
05/27/2006
Last updated
06/02/2008
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