Provider Demographics
NPI:1538618731
Name:AMARANTHINE, KRISTEN (DPT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:AMARANTHINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 GRATTAN ST # 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-3808
Mailing Address - Country:US
Mailing Address - Phone:949-422-3767
Mailing Address - Fax:
Practice Address - Street 1:12 W 37TH ST
Practice Address - Street 2:#1202
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7480
Practice Address - Country:US
Practice Address - Phone:212-777-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist