Provider Demographics
NPI:1598118507
Name:PIETRO, MARIA CHRISTINE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:CHRISTINE
Last Name:PIETRO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 POPLAR DR APT 75
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4672
Mailing Address - Country:US
Mailing Address - Phone:518-705-6016
Mailing Address - Fax:
Practice Address - Street 1:3265 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4122
Practice Address - Country:US
Practice Address - Phone:541-816-4747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040746-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist