Healthcare Provider Details

I. General information

NPI: 1942608898
Provider Name (Legal Business Name): KRISTIAN KNUTSON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BERNAL RD STE 30
SAN JOSE CA
95119-1396
US

IV. Provider business mailing address

4205 SAN FELIPE RD STE 100
SAN JOSE CA
95135-1503
US

V. Phone/Fax

Practice location:
  • Phone: 408-227-2141
  • Fax:
Mailing address:
  • Phone: 408-841-7203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: