Kourtney Marie Kingsmore

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT304051 Issued in CA

Practice address

1000 Calle Amanecer
San Clemente, CA 92673-6214

Phone

(949) 498-5100

NPI assigned

Oct 30, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1144093477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 1/2 RUBY AVE",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926624802",
            "telephone_number": "805-501-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CALLE AMANECER",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736214",
            "telephone_number": "949-498-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGSMORE",
        "first_name": "KOURTNEY",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-30",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "CA",
            "license": "PT304051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reza Khodadadi
• Nicole Kielkowicz, DC
• James Inkyu Kim, L. AC.
• Kineticx Physical Therapy & Performance
• Kineticx Physical Therapy & Performance P C
• Kaitlin Kinnamont
• Tanya Nilcia Kinton, M.S., OT
• Ashley Kirkland, IBCLC
• Richard P Klimkowski, MD
• Ligi Luke Klink, MSAC

• Pediatric Physical Therapist in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Pediatric Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.