Provider Demographics
NPI:1376307579
Name:KIRK, TEMELIA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:TEMELIA
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11218 PROVIDENCE RD W STE C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4787
Mailing Address - Country:US
Mailing Address - Phone:704-780-1558
Mailing Address - Fax:704-780-1108
Practice Address - Street 1:11218 PROVIDENCE RD W STE C
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4787
Practice Address - Country:US
Practice Address - Phone:704-780-1558
Practice Address - Fax:704-780-1108
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP027956T174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist