Provider Demographics
NPI:1972238186
Name:LOPEZ SISCAMANIS, KRISTEN MARIAH (DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIAH
Last Name:LOPEZ SISCAMANIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIAH
Other - Last Name:LOPEZ SISCAMANIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:62 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-3176
Mailing Address - Country:US
Mailing Address - Phone:401-450-2323
Mailing Address - Fax:
Practice Address - Street 1:62 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3176
Practice Address - Country:US
Practice Address - Phone:401-450-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty