Provider Demographics
NPI:1104156942
Name:FERRETTI, CRISTA (MSOTR/L)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:
Last Name:FERRETTI
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WESTSHORE BLVD
Mailing Address - Street 2:SUITE 601
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1140
Mailing Address - Country:US
Mailing Address - Phone:813-371-3410
Mailing Address - Fax:800-543-0372
Practice Address - Street 1:600 N WESTSHORE BLVD
Practice Address - Street 2:SUITE 601
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1140
Practice Address - Country:US
Practice Address - Phone:813-371-3410
Practice Address - Fax:800-543-0372
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11403171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor