Provider Demographics
NPI:1952668345
Name:LOSARITO, KRISTINE CARMELA PEREZ
Entity Type:Individual
Prefix:
First Name:KRISTINE CARMELA
Middle Name:PEREZ
Last Name:LOSARITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4058
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-4058
Mailing Address - Country:US
Mailing Address - Phone:301-498-2212
Mailing Address - Fax:
Practice Address - Street 1:13946 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5000
Practice Address - Country:US
Practice Address - Phone:301-498-2212
Practice Address - Fax:301-498-2213
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD240042251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics