Provider Demographics
NPI:1386291607
Name:SIMPSON, KIRKLAND (PTA)
Entity type:Individual
Prefix:
First Name:KIRKLAND
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 W LANGMEAD DR
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4526
Mailing Address - Country:US
Mailing Address - Phone:479-799-5303
Mailing Address - Fax:
Practice Address - Street 1:1801 FOREST HILLS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3071
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4478225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant