Provider Demographics
NPI:1427313683
Name:WULFING, KRISTEN ANN (DPT)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ANN
Last Name:WULFING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ANN
Other - Last Name:FONTANELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:73 NEWTON RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2424
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:1350 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2760
Practice Address - Country:US
Practice Address - Phone:860-697-6472
Practice Address - Fax:860-648-2876
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009456225100000X
NCP14025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076588Medicare PIN