Provider Demographics
NPI:1922655711
Name:KITAMURA, MARIN (PT)
Entity Type:Individual
Prefix:
First Name:MARIN
Middle Name:
Last Name:KITAMURA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W 158TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3801
Mailing Address - Country:US
Mailing Address - Phone:310-499-8567
Mailing Address - Fax:
Practice Address - Street 1:7860 IMPERIAL HWY STE C
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3464
Practice Address - Country:US
Practice Address - Phone:562-869-8525
Practice Address - Fax:562-869-7786
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist