Krystal Jenness, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0400000972 Issued in VT

Practice address

1282 Main St
Fairfax, VT 05454-9534

Phone

(802) 849-9308

Fax

(802) 849-9752

NPI assigned

Jul 4, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in VT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Vermont College of Medicine, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairfax Family Physical Therapy, P.C.Group PAC ID 2365519857, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fairfax Family Physical Therapy, P.C.

  • Physical Therapist
  • Fairfax, VT
  • NPI 1275797276
  Medicare reassignment Care Compare group NPD Authorized official
• Fairfax Family Physical Therapy P.C.

  dba Fairfax Family Physical Therapy P.C. DME

  • Durable Medical Equipment & Medical Supplies
  • Fairfax, VT
  • NPI 1477706257
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114957131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 LLOYD RD",
            "city": "FAIRFAX",
            "state": "VT",
            "postal_code": "054544403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1282 MAIN ST",
            "city": "FAIRFAX",
            "state": "VT",
            "postal_code": "054549534",
            "telephone_number": "802-849-9308",
            "fax_number": "802-849-9752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNESS",
        "first_name": "KRYSTAL",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VT",
            "license": "0400000972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PROVIDER #",
            "identifier": "9150484",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP PROVIDER #",
            "identifier": "364674",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1006936",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF VT PROVIDER #",
            "identifier": "29696",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fairfax Family Physical Therapy, P.C.
• Crystal Poirier Fisher, LICSW, LADC
• David Alan Fisher, MA, MA ED,
• Franklin West Supervisory Union
• Maegan Garrett, LICSW
• Melissa Laflin, PT, DPT, ATC
• Jacquelyn Lewis, LMT, NCTMB, CCA
• Lisa A Long, DPT
• Teig D Marco, M.D.
• John Paul Marriott, ND

• Physical Therapist in Fairfax, VT
• Providers in Fairfax, VT by specialty
• Physical Therapist in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.