Provider Demographics
NPI:1003625393
Name:GARNEAU, KRISTY ROSE (LMT)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:ROSE
Last Name:GARNEAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MORNING ST APT 17
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3268
Mailing Address - Country:US
Mailing Address - Phone:207-890-4313
Mailing Address - Fax:
Practice Address - Street 1:808 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3068
Practice Address - Country:US
Practice Address - Phone:207-797-5868
Practice Address - Fax:207-797-5498
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty