Provider Demographics
NPI:1962188821
Name:KIRSTEN MATSUNAGA DPT LLC
Entity type:Organization
Organization Name:KIRSTEN MATSUNAGA DPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-356-0766
Mailing Address - Street 1:13253 STYER COURT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20777
Mailing Address - Country:US
Mailing Address - Phone:301-356-0766
Mailing Address - Fax:
Practice Address - Street 1:8894 STANDFORD BLVD SUITE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:301-356-0766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy