Provider Demographics
NPI:1174158356
Name:MOZZICATO, KRISTINA (LMT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MOZZICATO
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 1:75 AVONWOOD RD APT A14
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2089
Mailing Address - Country:US
Mailing Address - Phone:860-778-0315
Mailing Address - Fax:
Practice Address - Street 1:2 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1445
Practice Address - Country:US
Practice Address - Phone:860-778-0315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist