Provider Demographics
NPI:1164085254
Name:RUBY, KRISTINA MARY (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARY
Last Name:RUBY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 PHOENIX ST
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1451
Mailing Address - Country:US
Mailing Address - Phone:570-540-6750
Mailing Address - Fax:
Practice Address - Street 1:301 LAKE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-7752
Practice Address - Country:US
Practice Address - Phone:570-266-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist