Provider Demographics
NPI:1518936277
Name:PEREIRA, KRISTY JEAN (MPT, CERT MDT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:JEAN
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:MPT, CERT MDT
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:JEAN
Other - Last Name:KOPSAFTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-3721
Mailing Address - Country:US
Mailing Address - Phone:716-863-2342
Mailing Address - Fax:
Practice Address - Street 1:3735 EASTON NAZARETH HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8338
Practice Address - Country:US
Practice Address - Phone:908-454-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0305022251X0800X
NJQA011730225100000X
PADAPT0054932251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist