Provider Demographics
NPI:1457447724
Name:HEATHERS, KIRK T (PT)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:T
Last Name:HEATHERS
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 1:1220 LAGUNA ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-2330
Mailing Address - Country:US
Mailing Address - Phone:765-454-5340
Mailing Address - Fax:765-454-5347
Practice Address - Street 1:1226 E HOFFER ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5727
Practice Address - Country:US
Practice Address - Phone:765-868-4686
Practice Address - Fax:765-868-4691
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009034A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist