Provider Demographics
NPI:1922535822
Name:GRECO, KRISTINE MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARIE
Last Name:GRECO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:KRSITNE
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4657
Mailing Address - Country:US
Mailing Address - Phone:203-438-5555
Mailing Address - Fax:
Practice Address - Street 1:27 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4657
Practice Address - Country:US
Practice Address - Phone:203-438-7862
Practice Address - Fax:844-409-2349
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist