Provider Demographics
NPI:1992015119
Name:CARMICHAEL, KIRSTEN (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:CARMICHAEL
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 1:3291 SWETZER RD
Mailing Address - Street 2:
Mailing Address - City:LOOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:95650-7607
Mailing Address - Country:US
Mailing Address - Phone:530-601-9729
Mailing Address - Fax:530-746-0657
Practice Address - Street 1:3291 SWETZER RD
Practice Address - Street 2:
Practice Address - City:LOOMIS
Practice Address - State:CA
Practice Address - Zip Code:95650-7607
Practice Address - Country:US
Practice Address - Phone:530-601-9729
Practice Address - Fax:530-746-0657
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist