Provider Demographics
NPI:1447800230
Name:MATTHEWS, KRISTINA CIARA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:CIARA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 PYRAMID WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2160
Mailing Address - Country:US
Mailing Address - Phone:775-322-4650
Mailing Address - Fax:775-322-3137
Practice Address - Street 1:2261 PYRAMID WAY STE 5
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2160
Practice Address - Country:US
Practice Address - Phone:775-322-4650
Practice Address - Fax:775-322-3137
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner