Provider Demographics
NPI:1326241027
Name:VITALE, KRISTI ANN I (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:ANN
Last Name:VITALE
Suffix:I
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:
Practice Address - Street 1:403 W. STANLEY STREET
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252
Practice Address - Country:US
Practice Address - Phone:360-691-4835
Practice Address - Fax:360-691-2545
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00012022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0281089OtherL & I