Provider Demographics
NPI:1457643009
Name:BIRK, MAUREEN R (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:R
Last Name:BIRK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 E 14TH ST
Mailing Address - Street 2:ST. PAUL ELDER SERVICES
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3304
Mailing Address - Country:US
Mailing Address - Phone:920-766-6020
Mailing Address - Fax:
Practice Address - Street 1:316 E 14TH ST
Practice Address - Street 2:ST. PAUL ELDER SERVICES
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3304
Practice Address - Country:US
Practice Address - Phone:920-766-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI996-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist