Provider Demographics
NPI:1083036024
Name:KIRK, ANNE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:KIRK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 ROTHROCK RD
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3132
Mailing Address - Country:US
Mailing Address - Phone:330-526-3496
Mailing Address - Fax:330-576-3496
Practice Address - Street 1:528 ROTHROCK RD
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-3132
Practice Address - Country:US
Practice Address - Phone:330-526-3496
Practice Address - Fax:330-576-3496
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03262225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant