Provider Demographics
NPI:1578689006
Name:ROY, KRISTINE MARIE
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:ROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6248
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87197-6248
Mailing Address - Country:US
Mailing Address - Phone:505-345-3909
Mailing Address - Fax:
Practice Address - Street 1:1201 EUBANK BLVD NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5386
Practice Address - Country:US
Practice Address - Phone:505-264-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2875225100000X
AZ6013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0446800OtherAZ BCBS SOMETHING'S MOVIN