Provider Demographics
NPI:1053582437
Name:NORDLUND, KIRSTIN (LMT)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:NORDLUND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8353 SW 124TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5851
Mailing Address - Country:US
Mailing Address - Phone:786-732-6915
Mailing Address - Fax:
Practice Address - Street 1:8353 SW 124TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5851
Practice Address - Country:US
Practice Address - Phone:786-732-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055848208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 58176OtherMASSAGE