Healthcare Provider Details

I. General information

NPI: 1427313683
Provider Name (Legal Business Name): KRISTEN ANN WULFING DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN ANN FONTANELLA DPT

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 SULLIVAN AVE
SOUTH WINDSOR CT
06074-2760
US

IV. Provider business mailing address

73 NEWTON RD STE 101
PLAISTOW NH
03865-2424
US

V. Phone/Fax

Practice location:
  • Phone: 860-697-6472
  • Fax: 860-648-2876
Mailing address:
  • Phone: 978-388-7272
  • Fax: 978-388-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009456
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP14025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: