Healthcare Provider Details

I. General information

NPI: 1922400068
Provider Name (Legal Business Name): KRISTIN MARIE MEZA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 HAYDENVILLE RD
LEEDS MA
01053-9767
US

IV. Provider business mailing address

349 HAYDENVILLE RD
LEEDS MA
01053-9767
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-7700
  • Fax: 413-586-8137
Mailing address:
  • Phone: 413-586-7700
  • Fax: 413-586-8137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21384
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: