Provider Demographics
NPI:1598735276
Name:OLIVOTTI, KRISTINE DIANE (MPT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:DIANE
Last Name:OLIVOTTI
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8817 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2329
Mailing Address - Country:US
Mailing Address - Phone:919-749-3884
Mailing Address - Fax:919-870-4447
Practice Address - Street 1:8305 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3546
Practice Address - Country:US
Practice Address - Phone:919-870-4444
Practice Address - Fax:919-870-4447
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211241Medicaid
NC7211241Medicaid