Healthcare Provider Details

I. General information

NPI: 1205224938
Provider Name (Legal Business Name): NATHAN KINDSTRAND PT, DPT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 MARENGO ST #102
LOS ANGELES CA
90033-1036
US

IV. Provider business mailing address

15000 KENSINGTON PARK DR STE 110
TUSTIN CA
92782-1831
US

V. Phone/Fax

Practice location:
  • Phone: 714-864-4741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number291908
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: