Provider Demographics
NPI:1407543275
Name:DEVORA, KRISTINA (PT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:DEVORA
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 1:765 NOSTRAND AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4203
Mailing Address - Country:US
Mailing Address - Phone:718-540-8808
Mailing Address - Fax:
Practice Address - Street 1:765 NOSTRAND AVE BSMT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4203
Practice Address - Country:US
Practice Address - Phone:718-540-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty