Organization Name: | KIRK CENTER FOR HEALTHY LIVING, PC |
NPI Number: | 1124065743 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRANDI DAWN KIRK (PHYSICAL THERAPIST PRESIDENT) |
Mailing Address: | 14815 Founders Xing Homer Glen |
State: | IL US |
Postal Code: | 604916705 |
Phone Number: | 7083013102 |
Fax Number: | 7083014450 |
NPI Enumeration Date: | 06/01/2006 |
NPI Last Update Date: | 12/07/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |