Provider Demographics
NPI:1962831891
Name:NEGOSHIAN, KRISTEN A
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:NEGOSHIAN
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 1:203 OAK ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1344
Mailing Address - Country:US
Mailing Address - Phone:508-651-0051
Mailing Address - Fax:508-651-0061
Practice Address - Street 1:54 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3208
Practice Address - Country:US
Practice Address - Phone:781-237-0400
Practice Address - Fax:781-772-1668
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist