Provider Demographics
NPI:1295242501
Name:KINNEY, KAMERYN (PT)
Entity type:Individual
Prefix:MRS
First Name:KAMERYN
Middle Name:
Last Name:KINNEY
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 1:1333 8TH AVE UNIT 703
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-4622
Mailing Address - Country:US
Mailing Address - Phone:951-765-7937
Mailing Address - Fax:
Practice Address - Street 1:740 NORDAHL RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3543
Practice Address - Country:US
Practice Address - Phone:760-432-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2941272251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic