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General NPI Number Information
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NPI Number | 1669660833
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Entity Type | Organization
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Legal Business Name | KIRSTEN E DUMFORD
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 2039 CRINELLA DR
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City | PETALUMA
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State | CA
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Zip | 94954-5627
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Country | US
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Telephone | 415-847-2097
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Fax | 707-981-8404
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Provider Business Mailing Address
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Address Line | 2039 CRINELLA DR
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City | PETALUMA
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State | CA
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Zip | 94954-5627
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Country | US
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Telephone | 415-847-2097
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Fax | 707-981-8404
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTEN DUMFORD
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Credential | P.T.
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Telephone | 415-847-2097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 0PT20442
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License Number State | CA
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