Healthcare Provider Details

I. General information

NPI: 1194777250
Provider Name (Legal Business Name): KRISTINA MARIE WELSOME MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WYNDHAM LN
NEW CITY NY
10956-4511
US

IV. Provider business mailing address

8 WYNDHAM LN
NEW CITY NY
10956-4511
US

V. Phone/Fax

Practice location:
  • Phone: 845-634-0143
  • Fax:
Mailing address:
  • Phone: 845-634-0143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number017479
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: