Provider Demographics
NPI:1609939339
Name:FAMIGLIETTI, KRISTIN K (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:K
Last Name:FAMIGLIETTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:102 IRVING ST NW
Mailing Address - Street 2:ATTN: MHPY PAYOR ENROLLMENT
Mailing Address - City:WASHINGTON DC
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2921
Mailing Address - Country:US
Mailing Address - Phone:301-581-8054
Mailing Address - Fax:301-564-0284
Practice Address - Street 1:24035 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-4871
Practice Address - Country:US
Practice Address - Phone:301-373-2588
Practice Address - Fax:301-373-4558
Is Sole Proprietor?:No
Enumeration Date:2006-12-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist