Provider Demographics
NPI:1194542597
Name:MARRUFO-GOFORTH, KRISTINA M (LMT)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:M
Last Name:MARRUFO-GOFORTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 CEDARCROFT DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-4429
Mailing Address - Country:US
Mailing Address - Phone:732-674-3820
Mailing Address - Fax:
Practice Address - Street 1:334 CEDARCROFT DR
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-4429
Practice Address - Country:US
Practice Address - Phone:732-674-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01376500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty