Provider Demographics
NPI:1083863302
Name:KIRKPATRICK, BRYAN (PT, MS, OCS)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:PT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E DIMOND BLVD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1908
Mailing Address - Country:US
Mailing Address - Phone:907-868-8686
Mailing Address - Fax:907-868-8637
Practice Address - Street 1:300 E DIMOND BLVD
Practice Address - Street 2:SUITE 16
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1908
Practice Address - Country:US
Practice Address - Phone:907-868-8686
Practice Address - Fax:907-868-8637
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK1651174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist