Provider Demographics
NPI:1720747108
Name:MORIARTY, KRISTIN E (ATC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ANN
Other - Last Name:EMERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:20 TOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3640
Mailing Address - Country:US
Mailing Address - Phone:203-432-4674
Mailing Address - Fax:
Practice Address - Street 1:20 TOWER PKWY
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3640
Practice Address - Country:US
Practice Address - Phone:203-432-4674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0007332081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine