Provider Demographics
NPI:1376800466
Name:KIRKHAM, CASEY (PT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:KIRKHAM
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 1:6825 BURDEN BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5633
Mailing Address - Country:US
Mailing Address - Phone:575-257-8200
Mailing Address - Fax:
Practice Address - Street 1:211 SUDDERTH
Practice Address - Street 2:LINCOLN COUNTY MEDICAL CENTER
Practice Address - City:RUIDOSO,
Practice Address - State:NM
Practice Address - Zip Code:88345-6002
Practice Address - Country:US
Practice Address - Phone:575-257-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist