Provider Demographics
NPI:1871169904
Name:CORRETTE, KRISTINA NICOLE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:NICOLE
Last Name:CORRETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:NICOLE
Other - Last Name:GALLASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 GLENSTONE DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4202
Mailing Address - Country:US
Mailing Address - Phone:860-836-0571
Mailing Address - Fax:
Practice Address - Street 1:915 SULLIVAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2165
Practice Address - Country:US
Practice Address - Phone:860-644-2335
Practice Address - Fax:888-974-2148
Is Sole Proprietor?:No
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist