Provider Demographics
NPI:1275123580
Name:MURDOCK, KRISTINA (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:47 TURKEY COVE RD
Mailing Address - Street 2:
Mailing Address - City:TENANTS HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04860-5200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:47 TURKEY COVE RD
Practice Address - Street 2:
Practice Address - City:TENANTS HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04860-5200
Practice Address - Country:US
Practice Address - Phone:207-701-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT1587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist