Provider Demographics
NPI:1386993822
Name:KRISTENSEN, MARC JEREMY (DPT)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:JEREMY
Last Name:KRISTENSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PARNASSUS AVENUE
Mailing Address - Street 2:A68
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0228
Mailing Address - Country:US
Mailing Address - Phone:415-353-1756
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVENUE
Practice Address - Street 2:A68
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0228
Practice Address - Country:US
Practice Address - Phone:415-353-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist