Provider Demographics
NPI:1093296758
Name:DIMARTINO, KRISTINA LEE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEE
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 FAIRPORT NINE MILE POINT RD
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1904
Mailing Address - Country:US
Mailing Address - Phone:631-264-4589
Mailing Address - Fax:
Practice Address - Street 1:2154 FAIRPORT NINE MILE PT RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-8743
Practice Address - Country:US
Practice Address - Phone:585-364-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist