Provider Demographics
NPI:1265741433
Name:SALTVEDT, KIRSTEN BONUCCI (BS, LMT)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:BONUCCI
Last Name:SALTVEDT
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 WHISPERWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-8130
Mailing Address - Country:US
Mailing Address - Phone:321-427-7977
Mailing Address - Fax:
Practice Address - Street 1:529 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5461
Practice Address - Country:US
Practice Address - Phone:321-765-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0011659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist