Provider Demographics
NPI:1093827545
Name:KIRK, JAMES A (MPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:KIRK
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
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Mailing Address - Street 1:3737 TELEGRAPH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3464
Mailing Address - Country:US
Mailing Address - Phone:805-642-4678
Mailing Address - Fax:805-642-2038
Practice Address - Street 1:3737 TELEGRAPH RD
Practice Address - Street 2:SUITE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3464
Practice Address - Country:US
Practice Address - Phone:805-642-4678
Practice Address - Fax:805-642-2038
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT26752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26752BMedicare ID - Type UnspecifiedPHYSICAL THERAPIST