Provider Demographics
NPI:1487604690
Name:LUCIDO, KRISTA LYNN (DPT)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:LYNN
Last Name:LUCIDO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2701
Mailing Address - Country:US
Mailing Address - Phone:631-691-6900
Mailing Address - Fax:631-691-6910
Practice Address - Street 1:11 BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2701
Practice Address - Country:US
Practice Address - Phone:631-691-6900
Practice Address - Fax:631-691-6910
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025466-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14R01Medicare ID - Type UnspecifiedPHYSICAL THERAPIST