Provider Demographics
NPI:1427024751
Name:KIRK, LYNELLE E (PT CHT)
Entity Type:Individual
Prefix:
First Name:LYNELLE
Middle Name:E
Last Name:KIRK
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:LYNELLE
Other - Middle Name:E
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT CHT
Mailing Address - Street 1:1900 W WILLOW
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703
Mailing Address - Country:US
Mailing Address - Phone:580-233-1667
Mailing Address - Fax:580-233-5123
Practice Address - Street 1:1900 W WILLOW
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703
Practice Address - Country:US
Practice Address - Phone:580-233-1667
Practice Address - Fax:580-233-5123
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4502251H1200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
376561Medicare ID - Type Unspecified