Provider Demographics
NPI:1811129497
Name:RICHARDS, CRISTINA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:RODRIGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:499 FARMINGTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1933
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35 NOD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3826
Practice Address - Country:US
Practice Address - Phone:860-677-0739
Practice Address - Fax:860-677-1029
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8590225100000X
CT008590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT076572OtherMEDICARE GROUP ID