Provider Demographics
NPI:1487976031
Name:KIRK, JACQUELINE (LPTA)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 WINDSOR CIR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-8037
Mailing Address - Country:US
Mailing Address - Phone:662-231-1015
Mailing Address - Fax:
Practice Address - Street 1:485 WINDSOR CIR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-8037
Practice Address - Country:US
Practice Address - Phone:662-231-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant