Healthcare Provider Details

I. General information

NPI: 1629077169
Provider Name (Legal Business Name): KRISTINE L VROOMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 MOURNING DOVE ROAD
OAK BLUFFS MA
02557
US

IV. Provider business mailing address

RR1 BOX 475KK
EDGARTOWN MA
02539
US

V. Phone/Fax

Practice location:
  • Phone: 508-696-7923
  • Fax:
Mailing address:
  • Phone: 508-696-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: