Provider Demographics
NPI:1326000274
Name:HILLMAN, KIRK EDMOND (PT)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:EDMOND
Last Name:HILLMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18195-1526
Mailing Address - Country:US
Mailing Address - Phone:610-481-1372
Mailing Address - Fax:610-481-3931
Practice Address - Street 1:1320 MILL ROAD
Practice Address - Street 2:
Practice Address - City:QUACKETOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-7666
Practice Address - Fax:610-760-1721
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-07-23
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2014-07-23
Provider Licenses
StateLicense IDTaxonomies
PAPT013482L225100000X
NJ40QA0140900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001842143Medicaid
PA394529Medicare ID - Type UnspecifiedGROUP NUMBER