Healthcare Provider Details

I. General information

NPI: 1255868154
Provider Name (Legal Business Name): KIRSTEN MARIA MATSUNAGA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8894 STANFORD BLVD STE 104
COLUMBIA MD
21045-5161
US

IV. Provider business mailing address

13253 STYER CT
HIGHLAND MD
20777-9754
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-7246
  • Fax: 410-997-7226
Mailing address:
  • Phone: 410-997-7246
  • Fax: 833-496-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303903
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26495
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: