Provider Demographics
NPI:1447243225
Name:DECKER, KIRK S (MPT)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:S
Last Name:DECKER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 STATE HWY 257 SUITE 1
Mailing Address - Street 2:PO BOX 248
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0248
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:202 UNION ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1166
Practice Address - Country:US
Practice Address - Phone:814-827-8148
Practice Address - Fax:814-827-0349
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012509L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001768850 0004Medicaid
PA650021492OtherMEDICARE RAILROAD CG7782
120494604OtherDEPARTMENT OF LABOR
PA243225OtherUPMC
PA001768850 0002Medicaid
PA001768850 0003Medicaid
PA001768850 0006Medicaid
720498OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA001768850 0007Medicaid
PA001768850 0008Medicaid
12107036OtherCAQH
PA001768850 0005Medicaid
PA001768850 0011Medicaid
PA650021492OtherMEDICARE RAILROAD CG7782