Provider Demographics
NPI:1972766913
Name:MORAIS, KRISTIN L (MSPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:MORAIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WAMPANOAG TRAIL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1038
Mailing Address - Country:US
Mailing Address - Phone:401-433-4049
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:16 ARNOLD STREET
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-2902
Practice Address - Country:US
Practice Address - Phone:401-765-2030
Practice Address - Fax:401-769-7472
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02149225100000X
MA18243225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist