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General NPI Number Information
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NPI Number | 1932140068
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Entity Type | Individual
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Provider Name | KRISTIN MASSAMIRI MPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 150 AVENIDA CABRILLO SUITE B
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5595
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Country | US
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Telephone | 949-498-8312
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3336
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City | SAN CLEMENTE
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State | CA
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Zip | 92674-3336
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 24544
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License Number State | CA
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