Active NPI
Mark Sherwood Libby, PT
- Physical Therapist
- Woodstock, VT
National Provider Identifier
1619904588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 040 0003101
- Practice address
- 10606 RT 106 South
Woodstock, VT 05091 - Phone
- (802) 457-4213
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 040 0003101 | VT | Primary |
Addresses
Primary practice location
10606 RT 106 South
Woodstock, VT 05091
Mailing address
PO Box 28
Woodstock, VT 05091-0028
Phone (802) 457-4213
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38849 | Other | VT | BLUE CROSS/BLUE SHIELD |
| 439910 | Other | VT | MVP |
| OVN1901 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040 0003101 | VT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556582400000",
"number": "1619904588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28",
"city": "WOODSTOCK",
"state": "VT",
"postal_code": "050910028",
"telephone_number": "802-457-4213",
"fax_number": "802-457-9870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10606 RT 106 SOUTH",
"city": "WOODSTOCK",
"state": "VT",
"postal_code": "05091",
"telephone_number": "802-457-4213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBBY",
"first_name": "MARK",
"middle_name": "SHERWOOD",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2019-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VT",
"license": "040 0003101",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD",
"identifier": "38849",
"state": "VT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP",
"identifier": "439910",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "OVN1901",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodstock, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.