Provider Demographics
NPI:1316161409
Name:PAINTER, KIRK GIPSON (LPT)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:GIPSON
Last Name:PAINTER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-8115
Mailing Address - Country:US
Mailing Address - Phone:512-353-4575
Mailing Address - Fax:512-353-4580
Practice Address - Street 1:915 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-8115
Practice Address - Country:US
Practice Address - Phone:512-353-4575
Practice Address - Fax:512-353-4580
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1096741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1096741OtherPT LICENSE
TXPT1096741Medicare UPIN
TX1096741OtherPT LICENSE