Provider Demographics
NPI:1063752582
Name:MATSUOKA, CHRISTINA KEIKO (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KEIKO
Last Name:MATSUOKA
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 1:40 SOLDIERS PASS RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4780
Mailing Address - Country:US
Mailing Address - Phone:928-282-1237
Mailing Address - Fax:
Practice Address - Street 1:40 SOLDIERS PASS RD
Practice Address - Street 2:SUITE 5
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4780
Practice Address - Country:US
Practice Address - Phone:928-282-1237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4430225100000X
CAPT16876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist