Provider Demographics
NPI:1760908602
Name:MACRAE, KRISTINA (PT,DPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MACRAE
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 1:3175 EMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1724
Mailing Address - Country:US
Mailing Address - Phone:718-891-0680
Mailing Address - Fax:718-891-0681
Practice Address - Street 1:267 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-6236
Practice Address - Country:US
Practice Address - Phone:551-230-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2024-02-16
Deactivation Date:2024-01-08
Deactivation Code:
Reactivation Date:2024-02-07
Provider Licenses
StateLicense IDTaxonomies
NY042071225100000X
NJ40QA02159100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist