Provider Demographics
NPI:1073495909
Name:JOSEPH, KRISTIE MELISSA (PT)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MELISSA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 NE 175TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2141
Mailing Address - Country:US
Mailing Address - Phone:786-859-6244
Mailing Address - Fax:
Practice Address - Street 1:373 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-2305
Practice Address - Country:US
Practice Address - Phone:786-916-3482
Practice Address - Fax:786-916-6093
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT41913OtherMEDICAL LICENSE