Provider Demographics
NPI:1699948653
Name:KIRK, JEANINE N (PHYSICAL THERAPY)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:N
Last Name:KIRK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 JAY ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-6062
Mailing Address - Country:US
Mailing Address - Phone:334-361-6008
Mailing Address - Fax:
Practice Address - Street 1:298 JAY ST
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-6062
Practice Address - Country:US
Practice Address - Phone:334-361-6008
Practice Address - Fax:334-491-0500
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18075174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist