Provider Demographics
NPI:1164199980
Name:STETZEL, KRISTIN (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:STETZEL
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 1:46 CHIPMAN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4057
Mailing Address - Country:US
Mailing Address - Phone:973-670-3401
Mailing Address - Fax:
Practice Address - Street 1:209 COLUMBUS AVE FL 4
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5109
Practice Address - Country:US
Practice Address - Phone:857-246-8234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist