Provider Demographics
NPI:1861883787
Name:DALOISI, KRISTIN A (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:DALOISI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:A
Other - Last Name:BRUZZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:57 GRAVES ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5120
Mailing Address - Country:US
Mailing Address - Phone:917-250-6888
Mailing Address - Fax:
Practice Address - Street 1:57 GRAVES ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5120
Practice Address - Country:US
Practice Address - Phone:917-250-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017632-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist