Provider Demographics
NPI:1851469944
Name:SULDA, KRISTIE BETH (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:BETH
Last Name:SULDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIE
Other - Middle Name:BETH
Other - Last Name:WRISLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:306 HIGH ST # A
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2611
Mailing Address - Country:US
Mailing Address - Phone:413-773-3379
Mailing Address - Fax:413-772-2705
Practice Address - Street 1:306 HIGH ST # A
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2611
Practice Address - Country:US
Practice Address - Phone:413-773-3379
Practice Address - Fax:413-772-2705
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA363700OtherTUFTS
MA0332691Medicaid
MAY67918OtherBCBS
MA56034OtherFALLON
MA0332691Medicaid