Provider Demographics
NPI:1245429620
Name:IRWIN, KIMBERLY M (PTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:M
Last Name:IRWIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:PORT SANILAC
Mailing Address - State:MI
Mailing Address - Zip Code:48469-0027
Mailing Address - Country:US
Mailing Address - Phone:810-622-0610
Mailing Address - Fax:
Practice Address - Street 1:7353 CEDAR STREET
Practice Address - Street 2:
Practice Address - City:PORT SANILAC
Practice Address - State:MI
Practice Address - Zip Code:48469-0027
Practice Address - Country:US
Practice Address - Phone:810-622-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant