Provider Demographics
NPI:1104043173
Name:BRIGGS, KIRK MAROY (PT)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:MAROY
Last Name:BRIGGS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2202 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2024
Mailing Address - Country:US
Mailing Address - Phone:310-446-3411
Mailing Address - Fax:310-446-6448
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:SUITE 330
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-832-7298
Practice Address - Fax:818-832-7249
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist