Provider Demographics
NPI:1255868154
Name:MATSUNAGA, KIRSTEN MARIA (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MARIA
Last Name:MATSUNAGA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13253 STYER CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777-9754
Mailing Address - Country:US
Mailing Address - Phone:410-997-7246
Mailing Address - Fax:833-496-1942
Practice Address - Street 1:8894 STANFORD BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5161
Practice Address - Country:US
Practice Address - Phone:410-997-7246
Practice Address - Fax:410-997-7226
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303903225100000X, 225100000X
MD26495225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist