Healthcare Provider Details

I. General information

NPI: 1790106714
Provider Name (Legal Business Name): LINDSEY KURODA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BON AIR RD SUITE A105
LARKSPUR CA
94939-1143
US

IV. Provider business mailing address

1378 20TH AVE APT 2
SAN FRANCISCO CA
94122-1700
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-2007
  • Fax: 415-927-7272
Mailing address:
  • Phone: 808-358-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40848
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: