Healthcare Provider Details

I. General information

NPI: 1629260740
Provider Name (Legal Business Name): KRISTN ANNE ELDREDGE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 LAFAYETTE AVENUE
CANANDAIGUA NY
14424
US

IV. Provider business mailing address

3778 ARMINGTON RD
PALMYRA NY
14522-9606
US

V. Phone/Fax

Practice location:
  • Phone: 585-402-1007
  • Fax:
Mailing address:
  • Phone: 585-750-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number016995-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: