Provider Demographics
NPI:1104886795
Name:RUFFO, KRISTINA MARIE (PT MS)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIE
Last Name:RUFFO
Suffix:
Gender:F
Credentials:PT MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054
Mailing Address - Country:US
Mailing Address - Phone:518-439-3875
Mailing Address - Fax:
Practice Address - Street 1:4 AIRLINE DR
Practice Address - Street 2:SUITE 123
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-456-6653
Practice Address - Fax:518-456-7274
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02250851Medicaid
T19700Medicare UPIN
NY02250851Medicaid