Provider Demographics
NPI:1730937574
Name:KIRK, KELSEY (PT DPT)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 LARNARD ST
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-1323
Mailing Address - Country:US
Mailing Address - Phone:256-702-6698
Mailing Address - Fax:
Practice Address - Street 1:1931 CENTRAL PKWY SW STE S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6851
Practice Address - Country:US
Practice Address - Phone:256-309-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH11799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist