Provider Demographics
NPI:1750568093
Name:KINSMAN, SEAN (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:KINSMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:782B SANCHES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94129-5214
Mailing Address - Country:US
Mailing Address - Phone:415-754-8881
Mailing Address - Fax:
Practice Address - Street 1:1670 RIVIERA AVE STE 101
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-7316
Practice Address - Country:US
Practice Address - Phone:415-754-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21947225100000X
AK1490992251X0800X
COPTL.00162352251X0800X
MA193912251X0800X
NY0444382251X0800X
OK56562251X0800X
PAPT0283092251X0800X
IL700249452251X0800X
CT125612251X0800X
CA370912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist