Provider Demographics
NPI:1669660833
Name:KIRSTEN E DUMFORD
Entity Type:Organization
Organization Name:KIRSTEN E DUMFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:415-847-2097
Mailing Address - Street 1:2039 CRINELLA DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5627
Mailing Address - Country:US
Mailing Address - Phone:415-847-2097
Mailing Address - Fax:707-981-8404
Practice Address - Street 1:2039 CRINELLA DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5627
Practice Address - Country:US
Practice Address - Phone:415-847-2097
Practice Address - Fax:707-981-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PT20442225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty