Provider Demographics
NPI:1962707307
Name:SMERAGULIO, KRISTINA M (PT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:SMERAGULIO
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 1:1170 BULL HILL RD
Mailing Address - Street 2:
Mailing Address - City:GILBOA
Mailing Address - State:NY
Mailing Address - Zip Code:12076-3638
Mailing Address - Country:US
Mailing Address - Phone:518-827-7098
Mailing Address - Fax:
Practice Address - Street 1:76-147 ROYAL POINCIANA DR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2385
Practice Address - Country:US
Practice Address - Phone:808-327-6202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-16
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist