Provider Demographics
NPI:1457686214
Name:CONCA, CRISTINA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:L
Last Name:CONCA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:80 DENSLOW RD
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3103
Mailing Address - Country:US
Mailing Address - Phone:413-526-9969
Mailing Address - Fax:413-526-9960
Practice Address - Street 1:124 MYRON ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1420
Practice Address - Country:US
Practice Address - Phone:413-781-7538
Practice Address - Fax:413-781-0982
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA17592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist