Provider Demographics
NPI:1982945341
Name:MURTY, KRISTINA N (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:N
Last Name:MURTY
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 1:207 BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3002
Mailing Address - Country:US
Mailing Address - Phone:585-287-7922
Mailing Address - Fax:
Practice Address - Street 1:36 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1326
Practice Address - Country:US
Practice Address - Phone:585-287-7922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27025525225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist