Provider Demographics
NPI:1336395540
Name:KLISIEWICZ, KRISTIN MAE (PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MAE
Last Name:KLISIEWICZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 THAYER RD
Mailing Address - Street 2:
Mailing Address - City:MONSON
Mailing Address - State:MA
Mailing Address - Zip Code:01057-9420
Mailing Address - Country:US
Mailing Address - Phone:413-596-8117
Mailing Address - Fax:
Practice Address - Street 1:137 THAYER RD
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:MA
Practice Address - Zip Code:01057-9420
Practice Address - Country:US
Practice Address - Phone:413-596-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist