Provider Demographics
NPI:1124137849
Name:CESPED, KIRSTEN WOOD (PT (PHUSICAL THERAPI)
Entity type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:WOOD
Last Name:CESPED
Suffix:
Gender:F
Credentials:PT (PHUSICAL THERAPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUPERIOR ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11001
Mailing Address - Country:US
Mailing Address - Phone:516-233-1325
Mailing Address - Fax:
Practice Address - Street 1:5 SUPERIOR ROAD
Practice Address - Street 2:
Practice Address - City:BELLEROSE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11001
Practice Address - Country:US
Practice Address - Phone:516-233-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q30C31Medicare UPIN