Provider Demographics
NPI:1114330958
Name:KIRK, JODI MARIE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MARIE
Last Name:KIRK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:JODI
Other - Middle Name:MARIE
Other - Last Name:ARNOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:19 CREST RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2807
Mailing Address - Country:US
Mailing Address - Phone:860-276-7426
Mailing Address - Fax:
Practice Address - Street 1:45 MERIDEN AVE
Practice Address - Street 2:SOUTHINGTON CARE CENTER, REHAB DEPT
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3214
Practice Address - Country:US
Practice Address - Phone:860-378-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist