Individual
KOURTNEY MARIE KINGSMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 CALLE AMANECER, SAN CLEMENTE, CA 92673-6214
(949) 498-5100
Mailing address
206 1/2 RUBY AVE, NEWPORT BEACH, CA 92662-4802
(805) 501-9277
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT304051
CA
Other
Enumeration date
10/30/2023
Last updated
10/30/2023
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