Provider Demographics
NPI:1275506354
Name:SCALA, KRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:SCALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726
Mailing Address - Country:US
Mailing Address - Phone:631-842-4606
Mailing Address - Fax:631-842-0803
Practice Address - Street 1:1160 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726
Practice Address - Country:US
Practice Address - Phone:631-842-4606
Practice Address - Fax:631-842-0803
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0178751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ22G8QC201Medicare PIN
Q22G81Medicare UPIN