Provider Demographics
NPI:1023202348
Name:MATSUNO, CLIFTON (PT)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:
Last Name:MATSUNO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 E COURT LN
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-4239
Mailing Address - Country:US
Mailing Address - Phone:415-225-7879
Mailing Address - Fax:415-276-5739
Practice Address - Street 1:140 E COURT LN
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-4239
Practice Address - Country:US
Practice Address - Phone:415-225-7879
Practice Address - Fax:415-276-5739
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist