Provider Demographics
NPI:1194777250
Name:WELSOME, KRISTINA MARIE (MSPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:WELSOME
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 1:8 WYNDHAM LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4511
Mailing Address - Country:US
Mailing Address - Phone:845-634-0143
Mailing Address - Fax:
Practice Address - Street 1:8 WYNDHAM LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4511
Practice Address - Country:US
Practice Address - Phone:845-634-0143
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist