Provider Demographics
NPI:1093827545
Name:KIRK, JAMES A (MPT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:KIRK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 1ST ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93043-4316
Mailing Address - Country:US
Mailing Address - Phone:805-982-6335
Mailing Address - Fax:
Practice Address - Street 1:162 1ST ST BLDG 1402
Practice Address - Street 2:
Practice Address - City:PORT HUENEME
Practice Address - State:CA
Practice Address - Zip Code:93043-3464
Practice Address - Country:US
Practice Address - Phone:805-982-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26752BMedicare ID - Type UnspecifiedPHYSICAL THERAPIST