Provider Demographics
NPI:1538654777
Name:JAMO MORAIS, KRISTINA ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ROSE
Last Name:JAMO MORAIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 SARATOGA ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-5277
Mailing Address - Country:US
Mailing Address - Phone:207-447-0469
Mailing Address - Fax:
Practice Address - Street 1:141 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1438
Practice Address - Country:US
Practice Address - Phone:203-270-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11869OtherCT LICENSE
MAPTL23961OtherLICENSE