Provider Demographics
NPI:1104099985
Name:SMITH, KRISTINA REBEKKA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:REBEKKA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1114
Mailing Address - Country:US
Mailing Address - Phone:617-230-3278
Mailing Address - Fax:
Practice Address - Street 1:8W WATER ST
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1114
Practice Address - Country:US
Practice Address - Phone:617-230-3278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist