Individual
KRISTIE BETH SULDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
13212
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0332691
—
MA
01
—
363700
TUFTS
MA
01
—
56034
FALLON
MA
01
—
Y67918
BCBS
MA
Enumeration date
11/30/2006
Last updated
07/08/2007
Update your record
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