Provider Demographics
NPI:1386470722
Name:CODILLA, KRISTINA ANN (PT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:CODILLA
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 1:2 WASHINGTON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6017
Mailing Address - Country:US
Mailing Address - Phone:781-321-7000
Mailing Address - Fax:781-322-9678
Practice Address - Street 1:2 WASHINGTON ST STE 1
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-6017
Practice Address - Country:US
Practice Address - Phone:781-321-7000
Practice Address - Fax:781-322-9678
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist