Provider Demographics
NPI:1700274859
Name:KRYSTOFALSKI, AMY (RPT, CLT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KRYSTOFALSKI
Suffix:
Gender:F
Credentials:RPT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 DYER AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3236
Mailing Address - Country:US
Mailing Address - Phone:860-693-7777
Mailing Address - Fax:860-693-7779
Practice Address - Street 1:102 DYER AVE
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3236
Practice Address - Country:US
Practice Address - Phone:860-693-7777
Practice Address - Fax:860-693-7779
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist