Provider Demographics
NPI:1376362574
Name:LAWRENCE, KRISTINA (LMT,MMT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LMT,MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 READ ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-1122
Mailing Address - Country:US
Mailing Address - Phone:203-675-6254
Mailing Address - Fax:
Practice Address - Street 1:73 READ ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-1122
Practice Address - Country:US
Practice Address - Phone:203-675-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002275225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist