Provider Demographics
NPI:1164247581
Name:DACUNZA, KRISTEN (DPT)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:DACUNZA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MATAWAN AVE APT 145D
Mailing Address - Street 2:
Mailing Address - City:CLIFFWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07721-3015
Mailing Address - Country:US
Mailing Address - Phone:732-503-1464
Mailing Address - Fax:
Practice Address - Street 1:400 MATAWAN AVE APT 145D
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721-3015
Practice Address - Country:US
Practice Address - Phone:732-503-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02090000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist