Provider Demographics
NPI:1528708005
Name:BENOIT, KRISTY (EP)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:BENOIT
Suffix:
Gender:F
Credentials:EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2629
Mailing Address - Country:US
Mailing Address - Phone:802-324-6678
Mailing Address - Fax:802-316-3328
Practice Address - Street 1:100 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2629
Practice Address - Country:US
Practice Address - Phone:802-324-6678
Practice Address - Fax:802-316-3328
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT798897224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT798897OtherAMERICAN COLLEGE OF SPORTS MEDICINE