Provider Demographics
NPI:1164506374
Name:KIRKPATRICK, TERI DANIELLE (PT)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:DANIELLE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:DANIELLE
Other - Last Name:CULLIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:
Practice Address - Street 1:2500 DALLAS HWY SW STE 520
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2664
Practice Address - Country:US
Practice Address - Phone:678-383-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherCHAMPUS/TRICARE
GA65BBDVWMedicare PIN
GA511I650339Medicare PIN
GA511I650338Medicare PIN