Provider Demographics
NPI:1427641489
Name:BRYCE, CRYSTAL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:BRYCE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 WILLISTON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6008
Mailing Address - Country:US
Mailing Address - Phone:802-399-2318
Mailing Address - Fax:
Practice Address - Street 1:1879 WILLISTON RD STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6008
Practice Address - Country:US
Practice Address - Phone:802-399-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0134254225100000X
VT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist