Provider Demographics
NPI:1003368051
Name:CUA, KIRSTIE A (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:A
Last Name:CUA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-698-7720
Practice Address - Fax:951-698-7451
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.022361225100000X
CAPT292077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA224607Medicare PIN