Provider Demographics
NPI:1285948760
Name:KIRK, ALLISON B (LMT)
Entity type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:B
Last Name:KIRK
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 1:198 RUTLEDGE AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5817
Mailing Address - Country:US
Mailing Address - Phone:843-991-3444
Mailing Address - Fax:
Practice Address - Street 1:198 RUTLEDGE AVE
Practice Address - Street 2:STE 4
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5817
Practice Address - Country:US
Practice Address - Phone:843-991-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3538225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist