Provider Demographics
NPI:1093353419
Name:KIRTLAND, KATELIN (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:KATELIN
Middle Name:
Last Name:KIRTLAND
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 1:900 HAMMONDS RD
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-3358
Mailing Address - Country:US
Mailing Address - Phone:256-601-7909
Mailing Address - Fax:
Practice Address - Street 1:2301 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5517
Practice Address - Country:US
Practice Address - Phone:256-543-3467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA9611225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant