Provider Demographics
NPI:1255676573
Name:ANGELL, KRISTINE M
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:M
Last Name:ANGELL
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 1:16 MACBETH ST
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6333
Mailing Address - Country:US
Mailing Address - Phone:401-946-2820
Mailing Address - Fax:
Practice Address - Street 1:16 MACBETH ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6333
Practice Address - Country:US
Practice Address - Phone:401-946-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPTA00499225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant