Provider Demographics
NPI:1649788118
Name:CUNHA, KIRSTEN JULIANA (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:JULIANA
Last Name:CUNHA
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 MCCARTY DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-0001
Mailing Address - Country:US
Mailing Address - Phone:516-644-1465
Mailing Address - Fax:
Practice Address - Street 1:687 MCCARTY DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-3736
Practice Address - Country:US
Practice Address - Phone:516-644-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
FLAL59722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer