Provider Demographics
NPI:1972238186
Name:LOPEZ-SISCAMANIS, KRISTEN MARIAH
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIAH
Last Name:LOPEZ-SISCAMANIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MARIAH
Other - Last Name:SISCAMANIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:260 NARROW LN
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-2722
Mailing Address - Country:US
Mailing Address - Phone:617-901-6945
Mailing Address - Fax:
Practice Address - Street 1:91 POINT JUDITH RD UNIT D7
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3468
Practice Address - Country:US
Practice Address - Phone:401-584-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist