Provider Demographics
NPI:1093297541
Name:URGASAN, KIRSTIE (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTIE
Middle Name:
Last Name:URGASAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1247
Mailing Address - Country:US
Mailing Address - Phone:401-845-9787
Mailing Address - Fax:
Practice Address - Street 1:546 MAIN ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-7852
Practice Address - Country:US
Practice Address - Phone:401-821-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist