Provider Demographics
NPI:1669805131
Name:GOLDSTEIN, KRISTINE D (PT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:D
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 L ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1066
Mailing Address - Country:US
Mailing Address - Phone:619-271-7100
Mailing Address - Fax:619-781-8075
Practice Address - Street 1:630 L ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1066
Practice Address - Country:US
Practice Address - Phone:619-271-7100
Practice Address - Fax:619-781-8075
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180392251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics